Insurance CoverageA Massachusetts Court determined an Insurance Company cannot deny payment of ER services related to an auto accident just because the injured party did not return the PIP Application

April 15, 20140

A District Court in Massachusetts allowed a Hospital located in Concord to proceed with a trial to recover personal injury protection benefits resulting from an auto accident.  See Emerson Hospital v. Amica Mutual Insurance Company.  Amica Insurance Company argued their failure to pay for medical services to the Hospital after an auto accident was proper because the injured party did not return a PIP application for benefits.

The court noted “the failure of the injured party to submit a PIP application does not, as a matter of law, excuse Amica Insurance Company from its PIP obligation”.  MGL c. 90, S-34M, requires that a claim for PIP benefits shall be presented to the company providing such benefits within at least two years from the date of the accident, and shall include a written description of the nature and extent of injuries sustained, treatment received and contemplated and such other information as may assist in determining the amount due and payable.   In this case, the Insurance Company took the position they are not responsible to pay for the medical services because the PIP application was not completed within 2 years, and as a matter of law, they do not need to show any prejudice.  The court determined Amica’s position is wrong because in this case, the hospital submitted the proper itemized bills listing the charges as related to emergency treatment due to the auto accident.  Furthermore, Amica did not request the hospital to submit additional evidence.  Lastly, the court determined Amica Insurance Company did not appear to send the PIP application to the correct address and did not give the injured party the opportunity to cooperate with then.

The court determined it was an error for the insurance company to believe an injured party is the only one to properly initiate a medical claim for personal injury protection benefits.  If you or a loved one is having difficulty getting an insurance company to cover medical benefits as a result of a motor vehicle accident, The Mass Injury Group strongly encourages you to seek the advice of an experienced attorney to protect your rights.

COVID-19 Notice – We remain here for you and can answer any questions or concerns you may have. Learn More »