Does Health Insurance Cover Motor Vehicle Accidents in Massachusetts?

In the majority of car accidents in Massachusetts where injuries are sustained and medical expenses incurred, the injured parties are able to have at least a portion if not all of their medical costs paid by some form of medical insurance.

PIP Benefits in Massachusetts 

Massachusetts is one of only 12 no-fault states, meaning that injured parties in auto accidents can have their medical expenses covered to some extent regardless of who was at fault or caused the accident.  Most Massachusetts auto policies have PIP coverage (Personal Injury Protection) where claimants can recover up to $8,000 that is available for medical costs or 75% of lost wages, or for “replacement services” such as hiring someone to perform your household tasks. PIP is available not only for yourself but for anyone in your vehicle as well as for any pedestrian injured by your vehicle. 

If you have private health insurance such as Cigna or Blue Cross/Blue Shield (but not, for example, Mass Health), then PIP will cover the first $2,000 of your “reasonable and necessary” medical expenses.  The remainder will have to be paid by your private carrier, pursuant to the coverage available.  But if you do not have private insurance or if you have MassHealth or an ERISA-based plan or should your claim for benefits been denied for non-covered services by the health insurance company, then your medical expenses will be paid up to $8,000 by PIP.  It’s a bouncing-back-and-forth type of medical insurance management that you, or your attorney, will need to do.

Should your medical expenses be less than $8,000 (provided you have no private coverage) and you have some wage loss as a result of the car accident, then you can use the remainder of the $8,000 for wage losses.  You are entitled to 75% of those lost earnings up to the remainder of the PIP coverage. This too can be managed by you, or your attorney, as to what gets paid first, medicals or lost earnings.  

Med-Pay in Massachusetts 

Another resource for medical expenses is Med-pay, which is available, although too often not purchased, for auto liability policies.  Massachusetts insurers are required to offer at least $5,000 in coverage but this is only an option. You can certainly purchase more med-pay coverage such as $25,000 if you wish.  In a situation where you have $15,000 in medical costs after an accident and you have private health insurance, PIP is only obligated to pay the first $2,000 or up to $8,000 if you do not have private coverage or have MassHealth or an ERISA-backed plan. The remainder will be covered by med-pay up to its limits. 

Should your medical expenses exceed that covered by PIP and med-pay, then your private carrier will pay for the remainder according to its policy.  However, in all cases where they pay out, the private carrier has a right to subrogation so that if you make a claim against the at-fault motorist who caused the accident and your injuries, you or your personal injury attorney will have to pay back the carrier out of your settlement or monetary verdict proceeds.  In some cases, your personal injury attorney can negotiate a smaller amount to be paid to the health care carrier. 

Pain and Suffering Claims in Massachusetts 

Under Massachusetts no-fault law, you can only bring a claim for additional damages as well as pain and suffering if you meet any one of its threshold conditions:

  • You incurred medical expenses of over $2,000, or,
  • You suffered a serious injury such as permanent disfigurement, broken bones, or substantial loss of a body part or an essential bodily function including sight or hearing, or,
  • Your family member suffered fatal injuries

If you have no health insurance, the ambulance and hospital will assert a lien on any claim you make against the driver who negligently caused your accident.  This will be for any amount that remains unpaid out of the $8,000 maximum you were entitled to from your PIP benefits. Your personal injury attorney can help you find a medical care provider who will also take a lien on any settlement or monetary verdict. Negotiating directly with a healthcare provider is sometimes easier than with a healthcare insurer. 

Retain the Law Office of Burns and Jain 

Healthcare payments and coverage are disputed at times. If this occurs to you, do not hesitate to contact a personal injury attorney from Burns and Jain. In any injury claim, having an experienced personal injury attorney will ensure that you have the best opportunity for the settlement you deserve. Call us at (617) 227-7423 for a free consultation.