If you’ve been involved in an automobile accident, you may be wondering what personal injury protection (PIP) means and whether or not you’re covered
In this post, we’ll explain everything you need to know about this insurance coverage – including the expenses it pays for, the situations where coverage does not apply, how much it costs, and how to file a claim.
What is Personal Injury Protection (PIP) Coverage in Massachusetts?
Personal injury protection (PIP) is a type of auto insurance coverage that pays for the costs associated with injuries when you are involved in an accident. As part of your auto policy, PIP covers medical expenses for you and your passengers. It can also pay for replacement services and lost wages (if you are deemed unable to work after the collision). PIP benefits are available for up to two years after the date of your accident.
Massachusetts is one of 12 states that requires drivers to purchase personal injury protection (PIP) coverage. In Massachusetts, PIP is a “no-fault” benefit, meaning that insurers pay PIP claims for their policyholders regardless of who was responsible for the accident. Even if the accident is your fault, you can still file a PIP claim.
PIP will cover claims up to the state maximum limit of $8,000. This can include expenses related to:
In Massachusetts, PIP will pay up to $8,000 in medical bill expenses. If you do not have private health insurance, PIP will cover the first $8,000 of medical bills. Any expenses beyond that will need to be paid out of pocket.
If you do have private health insurance, PIP will typically pay for the first $2,000 in medical expenses, as well as any out-of-pocket expenses like deductibles or copays. Then, your health insurer will be responsible for the rest.
Recovering from injury may result in lost wages. So, Massachusetts PIP covers up to 75 percent of your gross weekly wages if you are determined by a physician to be unable to work.
If you are an employee of a company, your PIP benefit will be calculated based on your average weekly wage over the year leading up to the accident. If you are self-employed, the PIP insurer will still compensate you based on 75 percent of your average weekly earnings – you just need to verify your self-employment income.
Suppose, for instance, that your annual pay is $50,000. and you work 50 weeks of the year. Your PIP claim will pay you three-quarters of your average $1,000 weekly wage, which is $750. For each week that you are disabled by a doctor and actually out-of-work.
Interestingly, you do not need to be employed to claim lost wages in Massachusetts. If you are unemployed, your insurer may still pay what you lost in “earning power” – if you can prove you were able to and planning to take a job after the accident.
PIP also includes coverage for “replacement services.” These include expenses related to household work, like lawn care or cleaning services, that you are unable to perform because of your injuries.
Keep in mind that your total PIP claim benefit for medical expenses, lost wages and replacement services cannot exceed $8,000.
It’s also important to note that PIP doesn’t cover all the expenses related to your accident (more on this below). For this reason, you’ll want to ensure that you have adequate coverage through other elements of your auto insurance policy. This includes sufficient liability and collision coverage to pay for property damage – or even lawsuits you could face as a driver.
While PIP coverage will apply to most auto accidents, it doesn’t cover drivers under every situation.
You cannot claim PIP for accident-related expenses if:
- You were driving under the influence of drugs or alcohol when the accident happened.
- You deliberately caused the accident in question.
- You were injured as a motorcycle rider or passenger.
- You were working when the accident occurred and you have workers’ compensation insurance (In this case, the workers’ compensation pays for medical expenses and lost wages, not PIP).
- You were using the vehicle as part of a ride share, car share, or transportation network service.
- You were committing a felony or trying to evade arrest at the time of the accident.
Like any type of auto insurance coverage, how much PIP costs will depend on several rating factors – including your age, the size of your deductible, and other risk-related factors.
In Massachusetts, you can get no-deductible policies, but these have the highest premiums. As you increase the policy deductible, the cost of PIP coverage will decrease. No deductible policies are the best policies to have for just about everyone! If an insurance agent or anyone else suggests that you get a PIP deductible, please be sure to question this. Feel free to call us with any questions or to discuss the relative benefits to no deductible PIP coverage.
In general, the cost of your required PIP coverage in Massachusetts represents a small portion of your total auto policy premium – often less than five percent. This means PIP coverage can cost anywhere from $20 to more than $50 a year, depending on your auto insurance rates.
Generally, you do not have to repay any PIP benefits received in the state of Massachusetts.
The PIP limit in Massachusetts is $8,000. This means the maximum your insurer will pay for lost wages, medical bills, and replacement services is a total of $8,000.
Massachusetts sets the limit at this number to cover minor injuries and reduce the risk of litigation. However, the law does accommodate more serious injuries, which we discuss in the next section.
If you’re involved in an accident, your total medical and lost wage expenses can quickly surpass the $8,000 PIP limit – especially if you incur any medical complications. If that happens, you may need to bring a claim against the other driver for damages.
The purpose of PIP is to assure quick and easy medical and lost wage payments without the need to determine who was at fault in the accident.
However, $8,000.00 may not be sufficient to cover severe injuries, such as fractures, mTBI (head injury), disfigurement or other bodily injuries. In these cases, attorneys may recommend that you file a liability claim against the other party to recover further damages. If found responsible, the opposing party’s insurer must pay the sum either agreed to in a settlement or if no agreement can be negotiated, the judgment or award made by the Court. You must also prove that the other driver was at least fifty (50%) percent at fault for the collision. You cannot sue for damages if you were responsible for causing the accident.
Subrogation is a process designed to protect both you and your insurer in the event of a car accident that wasn’t your fault.
Suppose, for instance, that you are involved in a collision and the other driver was to blame. In this case, the “third-party carrier” – the opposing party’s insurer – must repay these PIP costs to your insurer to compensate them for the PIP claim.
Insurers handle reimbursement via the subrogation process. After an accident in Massachusetts that involves personal injuries, eventually, the insurer of the at-fault party makes a payment to the insurer of the innocent party.
To file an effective PIP claim in Massachusetts, you must follow the correct procedure.
The first step is to inform your insurance company of the accident. You should do this immediately, after calling emergency services and after being treated for your injuries.
Once you inform your insurer, they will send you paperwork concerning your injuries that you need to fill out. You’ll have to provide details including:
● The nature of the accident.
● The type of injuries you sustained.
● Any treatment you’ve received so far (for instance, if emergency services rushed you to the hospital following the collision).
You have up to two (2) years to provide your insurer with details related to your PIP claim. However, it’s best to provide documentation of your injury-related expenses as soon as they’re incurred. Otherwise, you may not be able to pay medical expenses or other bills – especially if your injury prevents you from working.
Once you submit all the relevant details, your insurance company may request an independent medical examination. During this process, a medical professional will perform a physical exam and either confirm or question the legitimacy of your injuries.
Once your insurer is convinced you’ve sustained real injuries, they will release funds to you, or pay your healthcare provider on your behalf.
Navigating a PIP claim in Massachusetts can be complicated. Therefore, it’s a very good idea to work with an experienced attorney who understands insurance law and can help when you need it.