By: Karen Piso Nadeau, Esq.

In Massachusetts, the vehicle that you are in or the vehicle that touches you usually provides the first $2,000.00 in coverage through no fault PIP benefits.

The short answer to who pays my medical bills if I am in an auto accident in Massachusetts is:

The auto insurance for the vehicle that you are in or the vehicle that touches you pays the first $2,000.00 in medical bills through no fault PIP coverage. Once the $2,000.00 is paid, your medical bills then shift to your health insurance to pay your medical bills in the usual manner your health insurance would pay. This is regardless of who is at fault for the accident.

When you are in an automobile accident in Massachusetts and suffer injuries requiring medical care, you are not thinking about the medical bills that are mounting and how they get paid. Your attention is on getting the medical care you or a loved one need to get better. Once you are home and recovering, at some point, hospital billing departments start calling you and perhaps you get notices of overdue balances or even a collection notice in the mail due to medical bills incurred as a result of your auto accident.

Sorting out the maze of who pays your medical bills related to the car accident is challenging for even those of us who have years of experience working in the personal injury field. Often the most frustrating issue is simply getting a human being on the phone that knows what they are doing to get your medical bill processed and paid. You would think it would be easy, but it is a complex system that can make you throw your hands up and not deal.  But this is not the answer when your medical bills need to be paid and they are outstanding. The issue of who pays needs to be addressed and often requires aggressive follow up and countless hours of phone calls and emails.

Understanding how the medical billing works when you are involved in an auto accident helps you maneuver the unfriendly billing systems in place to finally get your zero balance and breathe a sigh of relief. The collection notices cause another layer of unnecessary stress and anxiety. Often, the collection notices have lazy people behind them who find it easier in the billing department to have a collections notice sent to you than to do their job and roll up their sleeves and get the auto PIP coverage and health insurance coverage available to pay your bills.

This blog will identify the various types of victims in auto accidents and explain in simple terms how your bills get paid.

If You Are the Driver of a Vehicle

If you are the driver of a vehicle involved in an auto accident, the auto insurance for the car that you are operating typically covers you with no fault Personal Injury Protection benefits also known in the insurance industry as PIP benefits.  It does not matter if you are or are not at fault for the accident. PIP covers you usually up to $8,000.00 for your medical bills related to the auto accident.

It does not matter if you don’t own the vehicle that you are driving. It does not matter if you have your own auto insurance. The auto insurance for the car you are operating will cover your medical bills under PIP. If you have health insurance, PIP will pay the first $2,000.00 in medical bills. PIP will then give notice of $2,000.00 being paid usually in a PIP exhaust letter.  This PIP exhaust letter then triggers your personal health insurance to pay your medical bills in the usual course and according to your health insurance policy terms.

If you have deductibles to pay or copays, these medical expenses may be paid or reimbursed to you by the auto PIP coverage up to a total of $8,000.00.

If You Are a Passenger in a Vehicle

 If you are a passenger in a vehicle involved in an auto accident, the auto insurance for the vehicle that you are in will provide no fault Personal Injury Protection benefits to you. It does not matter if the driver caused the accident or not. PIP will provide you with $8,000.00 in coverage for medical expenses related to the accident.

It again does not matter if you have your own car and auto insurance policy. The auto insurance for the car in which you are a passenger will pay the first $2,000.00 in medical bills under PIP benefits if you have health insurance. PIP will then give notice that they have fulfilled their obligation and paid the $2,000.00 required with a PIP exhaust letter. This then triggers your health insurance to cover your outstanding medical bills related to the car crash according to the terms of your health insurance coverage.

If you have copays or a deductible, PIP will pay these or reimburse you for these expenses up to a total of $8,000.00 in PIP coverage.

If You Are a Pedestrian Struck by a Vehicle

 If you are a pedestrian struck by a motor vehicle and injured, the auto insurance for the vehicle that struck you will cover your medical expenses under the provisions of Personal Injury Protection benefits. PIP will provide you with a total of $8,000.00 in coverage for medical bills related to the car accident.

The fact that you or a household member may have their own auto insurance does not matter. You are covered under PIP by the car that hit you. The way it works is the first $2,000.00 in medical bills is paid by PIP. The insurance company then gives notice that they have satisfied their obligations under PIP with a $2,000 exhaust letter. This then shifts your outstanding medical bills to your health insurance to pay in accordance with the terms of your health insurance policy.

You have up to $8,000.00 in PIP coverage to pay any copays or deductibles or out of pocket medical expenses that you may be obligated to pay.

If You Are a Bicyclist Struck by a Motor Vehicle

If you are a bicyclist struck by a motor vehicle and injured, your medical expenses will be covered by the Personal Injury Protection benefits under the auto insurance for the car that hit you on your bike. Even if you or a household member has their own auto insurance, it does not matter. The car that made contact with you will be the auto insurance that provides the PIP benefits up to $8,000.00 for your medical bills related to the accident.

The first $2,000.00 in medical bills will be paid by PIP. Upon paying $2,000.00, the auto insurance will provide notice that they have met their obligation under PIP. The PIP exhaust then shifts the burden to your health insurance to pay your medical bills in the usual course.

Your copays and deductibles may be covered by PIP up to $8,000.00 total coverage.

If You Are on a Scooter or Skateboard Struck by an Automobile

Like a bicyclist, a person on a scooter or a skateboard also is covered by PIP provided by the auto that made contact with the victim injured in the accident. It works the same way. The first $2,000.00 in medical bills is paid by PIP. The PIP insurer then gives notice that they have met their requirement under the law. This then obligates your health insurer to pay your outstanding medical bills.

Again, your copays and deductibles may be covered by PIP up to $8,000.00.

What if You Have No Health Insurance?

It is unusual today for a person injured in a car crash to have no health insurance. However, if an injured party has no health insurance, the law requires PIP to cover up to $8,000.00 in medical expenses.  This means PIP would not stop paying at $2,000.00.  PIP would continue to pay the medical bills related to the auto accident up to the $8,000.00 in coverage.

PIP Deductibles May Limit or Exclude PIP Coverage

We are seeing an increase in PIP deductibles on our clients’ auto insurance policies in MA. Most of our clients are unaware that their auto policy has a PIP deductible until they are injured in a car crash and need the PIP benefits to cover them.  They learn after the fact that the PIP has been excluded for them on their own policy. You can’t go back and get the coverage after the accident.  It is too late.  You can get PIP coverage going forward for a future accident.

We had a client who suffered a fractured vertebrae requiring a lot of medical care. She incurred a lot of medical bills to address her injuries from the car crash and get better. She was shocked to learn that she had no PIP coverage on her insurance policy.  Since she was driving her own car when the car accident occurred, her PIP coverage would be on her own auto policy. She had a full PIP deductible which meant she had zero PIP coverage. This meant her health insurance deductibles and copayments could not be paid or reimbursed by PIP and it was a financial hardship for her.

Clients who have this PIP deductible are surprised to learn how little the PIP coverage costs. It is coverage that should not be excluded to try to save money on your auto policy. Often clients explain that no one at the insurance agency or insurance company told them that they were excluding this important PIP coverage or explained it to them. Even if you have health insurance, the PIP is coverage that should not be excluded as it provides an added layer of protection in a time of need. The lesson learned is to check your auto insurance policies to make sure you have this PIP coverage. It provides an added layer of protection and financial security if you are in an auto accident.

Health Insurance Plans Requiring PIP to Pay More than $2,000.00

There are some health insurance plans that legally require the no fault Personal Injury Protection to pay the full benefits and the full coverage which is $8,0000.00 before the health insurance is required to pay any medical bills. For example, Mass Health plans will not pay for any motor vehicle related medical bills until PIP is fully exhausted and pays their full $8,000.00 in coverage first.

There are also some private health insurance plans known as ERISA plans that require PIP to pay their full $8,000.00 in benefits before your health insurance must pay auto accident-related medical bills. This may be another reason that your medical bills are not timely processed and delayed. PIP sometimes is waiting for your health insurance to confirm it is not required to pay and fits into the special category of health insurance that requires PIP to pay their full coverage. In these circumstances, coordinating the benefits and figuring out why your bills are stuck in limbo often involves patience and persistence to get the job done and your bills to finally have a zero balance. Often the communication between the PIP insurance claims representative and medical billing departments is lacking.

At Nadeau Harkavy LLC, we have over 60 years combined experience representing injured people and their families when they have been involved in an auto accident. We have recovered millions of dollars in compensation for our clients over the years to help them get on with their lives after suffering the consequences of a serious accident.  We make sure everything is done to protect your interests while you and your family concentrate on getting better. We handle all types of car accident cases including wrongful death and brain injury. We represent drivers, passengers, pedestrians, bicyclists, as well as other types of car accident cases such as scooter and skateboard cases. We also handle other types of injury cases such as trip and fall, slip and fall, dog bite, construction site, and catastrophic injury accidents. If you or a loved one has been harmed through no fault of your own, call us today for a free consultation about your legal rights at 617-674-7640.