Who Pays My Medical Bills After a Car Accident in Massachusetts?

After a Massachusetts crash the first medical bills are paid by your own policy, not by the driver who caused it. M.G.L. c. 90, sec. 34M requires every motor vehicle liability policy issued in the commonwealth to carry personal injury protection, and M.G.L. c. 90, sec. 34A defines that benefit as payable “without regard to negligence or gross negligence or fault of any kind,” to the amount or limit of at least eight thousand dollars on account of injury to or death of any one person.

No-fault means no waiting for a fault decision

This is the part that saves people money and almost nobody knows. Fault investigations take weeks. Medical bills do not. Because section 34A makes the benefit payable without regard to fault, the treatment can start being paid for while the question of who caused the crash is still open. Waiting to see whether the other insurer accepts liability is a choice the statute does not require anyone to make.

The $8,000 is a floor written as “at least”

Section 34A says “at least eight thousand dollars,” which makes it the statutory minimum for the benefit rather than a fixed ceiling in every policy. The section also allows a policyholder to elect a deductible, which changes what actually gets paid out on a given policy. The eight thousand dollar figure is the right number to start from and the wrong number to assume without reading the policy.

The $2,000 rule that makes people think PIP was denied

Here is the single most misunderstood piece of Massachusetts no-fault, and it is written into section 34A. Personal injury protection shall not provide for payment of more than two thousand dollars of medical, surgical, x-ray and dental and related expenses if, and to the extent that, those expenses have been or will be paid under a policy of health, sickness or disability insurance. In plain terms: if you have health insurance, PIP covers the first two thousand dollars of medical bills, and after that the bills route through the health plan. The remaining PIP is still there for what health insurance does not cover, including lost wages. The section also says a health insurer may not deny coverage for those expenses because personal injury protection benefits exist.

Two deadlines and a ten-day clock

The claim has to be presented as soon as practicable after the accident and in every case within at least two years from the date of accident. The expenses section 34A covers are the ones incurred within two years of the accident. And once a licensed physician notifies the insurer of disability, section 34M gives the insurer ten days either to commence medical payments or to give written notice of its intent not to pay, with reasons.

The statute has teeth if the insurer stalls

Where benefits due and payable go unpaid for more than thirty days, section 34M deems the unpaid party a party to a contract with the insurer, opens an action in contract, and directs a district court to advance the case for a speedy trial on motion. If the unpaid party recovers a judgment for any amount due and payable, the court assesses costs and reasonable attorney’s fees against the insurer. That fee-shifting sentence is why an unpaid PIP claim is worth raising rather than absorbing.

What this page is not

This page describes what sections 34M and 34A say. It does not tell you what your policy provides, whether a particular bill is covered, or how the coordination rule applies to your health plan. Read the sections yourself at the links above, and telephone the firm about a real claim.