Personal Injury Protection (PIP): How it Works

You’ve been injured in a car crash. Who is going to pay for your medical expenses and/or lost wages? That’s where Personal Injury Protection, or PIP, benefits come into play. PIP benefits are included as part of any Massachusetts auto insurance policy but what exactly is it and how does it work?

PIP benefits are known as “no-fault” insurance coverage, which means that if you are in an accident, you are entitled to make a claim for your PIP benefits irrelevant of whether or not you or your vehicle was the cause of the accident. Benefits are paid only for medical expenses or losses actually incurred up to two years after the accident.

What do PIP benefits cover? In general, PIP benefits cover medical expenses, lost wages, and replacement services arising out of the accident.

Medical Expenses: PIP will pay all reasonable medical expenses incurred as a result of the accident for necessary medical, surgical, X-ray and dental services, including prosthetic devices. It also includes ambulance, hospital, professional, nursing and funeral services.

However, PIP can be complicated when it comes to medical expenses. If the claimant has private health insurance, PIP will pay the first $2,000 in medical bills. Subsequent bills will be billed to the health insurance. Any co-pays, deductibles, or other out-of-pocket expenses that the claimant incurs after health insurance has paid can be billed back to PIP for reimbursement. If the claimant does not have private health insurance, has health insurance through an ERISA plan, Medicare, Medicaid or other public plan, then PIP will pay up to $8,000 in medical bills. Reasonable medical bills must be incurred within two years from the date of the accident. Additionally, at any point, the insurer may request that the claimant submit to an Independent Medical Examination (IME). This is a medical exam by an insurance selected doctor who will decide if the medical treatment to date was reasonable and necessary and whether or not future medical treatment is required. If the IME doctor finds that future medical treatment is no longer required, then PIP will most likely refuse to pay any further medical bills even if the claimant continues to treat

The attorneys here at Studley Law Offices have a combined 45 years of experience representing people who have been injured in car crashes. We understand what you’re going through and we know how insurance companies work. If you have been injured in a car crash and would like to speak with us, please call us at 508-946-0070.