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WHAT IS PIP (Personal Injury Protection) in Massachusetts?

by | May 19, 2021 | Firm News |

What are PIP Benefits?

PIP refers to Personal Injury Protection Insurance Coverage (PIP). Massachusetts is a no-fault state with respect to motor vehicle accidents. Under this system, even when a driver is at fault, they are still entitled to have their lost wages and medical bills covered by PIP.

Does Everyone In MA Have PIP?

For years, PIP was standard on every automobile policy sold in Massachusetts. In recent years, new lower cost-insurers moved in. People who were chasing lower rates soon found themselves with policies that unwittingly waived PIP coverage. This is a dangerous trend that has left many individuals without the coverage that they needed. Further PIP is not available to individuals operating or riding on a motorcycle. For any individual with a motorcycle policy it is imperative that they purchase MedPay to ensure they have some protection from medical bills in the event of an accident.

What Types of Things Does PIP Cover?

PIP pays for all reasonable, related and necessary medical bills that arose out of the accident. If you are involved in an accident, your PIP benefits are paid by the insurance company that insures the motor vehicle that you were in at the time of the accident. This is an area that concerns many clients. I am often asked why their own policy is paying for things that are caused by someone else’s negligence. The reality is that in those situations, if another driver is liable for the accident, then that driver’s insurance company will reimburse your insurance company for your PIP benefits in a process called subrogation. PIP also covers up to 75% of lost wages. Clients can elect whether PIP is used exclusively on medical bills, lost wages, or a combination of the two.

How Much Will PIP Cover?

PIP will pay up to $8000 in coverage if you do not have private health insurance and rely on MassHealth coverage. PIP will also pay $8,000 for individuals with certain self-insured ERISA health insurance plans. In the majority of cases involving private health insurance though, PIP will pay the first $2000. Once your initial $2000 in medical bills is paid by PIP, PIP will send an exhaust letter. After that, the rest of the bills will be submitted for payment to the health insurance company.

Do I Have To Talk to My Insurance Company About My PIP Benefits?

To make a claim for PIP benefits, a client has to submit a PIP application to their own insurance company. This application seeks basic information regarding your accident, injuries, and health insurance. While it is not advisable to ever speak to the insurance company for the liable driver, with PIP benefits, clients have an obligation to cooperate with their own insurance company. An automobile insurance policy is a contract between the insurer and insured. When an insured fails to honor the contract, the insured can lose the PIP benefits offered under the policy.

Who is Not Entitled to PIP Benefits?

PIP is not available if:

  • You were on a motorcycle
  • You are entitled to receive Worker’s Compensation benefits for the same injuries
  • You were under the influence of alcohol or drugs, in the act of committing a felony, or intentionally caused injury