Dr. John, Esq. is both an attorney and a physician. Before obtaining his law degree, Dr. John Naranja practiced for approximately 12 years as an orthopedic surgeon.
By Marc Diller, Esq.
DILLER LAW, P.C.
1. Where can a person injured in a Massachusetts automobile accident find Medical Payments’ coverage (“Med Pay”) to pay for accident-related medical expenses?
In Massachusetts, generally, if a person suffers injury resulting from an automobile accident, such injured person should be entitled to accident-related medical expenses coverage under Med Pay regardless of fault. The insurance policy responsible for covering the injured person’s Med Pay benefits is:
First, the Massachusetts vehicle the injured person was occupying when the accident occurred covers accident-related medical expenses under Med Pay.
Second, if the vehicle the injured person was occupying at the time of the accident does not have Med Pay coverage, any automobile policy in which the injured person is a named insured or an insured’s “household member” covers accident-related medical expenses under Med Pay.
Third, if the injured person is a pedestrian struck by an automobile, such injured person’s own automobile policy or that of a “household member” will pay accident-related medical expenses under Med Pay.
2. When should a person injured in a Massachusetts automobile accident seek to pay accident-related medical expenses under Med Pay?
In general, any person injured in a Massachusetts motor vehicle accident should submit for payment needed medical expenses to the compulsory PIP insurer before submitting such medical expenses to the Med Pay insurer because compulsory coverage precedes optional coverage. In Massachusetts, PIP coverage is compulsory coverage, whereas Med Pay coverage is optional. Med Pay coverage generally applies only after the injured person has exhausted his PIP benefits to pay for accident-related medical expenses.
3. For a person injured in a Massachusetts automobile accident, does payment of accident related medical expenses under Med Pay affect the injured person’s settlement?
No! According to Massachusetts’ case law, payment of medical expenses pursuant to Med Pay coverage does not affect the case’s settlement because payment under Med Pay never triggers rights to recovery.
4. When will a Massachusetts Med Pay insurer not pay benefits for accident-related medical expenses?
In general, a Massachusetts Med Pay insurer will not pay accident-related medical expenses if:
(i) the injured person’s accident involved a vehicle used as a residence;
(ii) the injured person is entitled to worker’s compensation benefits as a result of the automobile accident,
(iii) at the time of the accident responsible for causing the injured person’s injuries the injured person was occupying a vehicle without reasonable belief that (s)he had the owner’s consent to use such vehicle, or
(iv) the vehicle, in which the injured person was in at the time of the accident belongs to the injured person or his household member and is not listed on the injured person’s household member’s insurance policy and the regular use exclusion applies; or
(v) the med pay insurer has the right to deny optional coverage under the relevant policy.
5. If a person injured in a Massachusetts automobile accident has private health insurance and fails to coordinate benefits under such health insurance policy, will that affect the payment of the injured person’s accident-related medical expenses under Med Pay?
In general, No! According to the Massachusetts Division of Insurance Bulletin No. B-90-2, an injured person’s reasonable and necessary accident-related medical expenses not paid by either the PIP insurer or the private health insurer will be payable by the relevant Med Pay insurer regardless of the injured person’s failure to cooperation with his health insurance plan.
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