What are Personal Injury Protection Benefits?

Hi everybody Mike Molloy managing attorney here at Marcotte Law Firm and this is going to be our first video in our youtube series um and the topic is something called personal injury protection benefits and this is generally known as something called PIP benefits and it’s a benefit for those who are injured in a car accident.

The history of it is is is not too long but you know back in the 70s before there were before everybody had health insurance what would happen is that people would get in car accidents and and they’d be really afraid if they have to go to the emergency room or take an ambulance and how am i going to pay these bills right away and it could keep people from getting the emergency services they need. So what the state did and a lot of states around the country did is they started this no-fault benefit that’ll pay for certain expenses no matter who’s fault a car accident is. So pretty much everybody who’s involved in a car accident is entitled to these benefits and it could pay for certain things.

The first thing you have to figure out with these benefits is which insurance company pays. If you’re in a car it’s the easiest as it’s most likely the car that you’re in is going to pay for these benefits. Even if some other car or another party is at fault and it’s not your fault, it doesn’t really change that at all. The insurance company of the car you’re in is going to pay these benefits. This doesn’t make your insurance rates go up or anything like that it’s just how the law works.

It can be a little different if you’re not in a car. If you’re a pedestrian or if you’re on a bike then if you’re struck by a car you’re entitled to these benefits and you’re entitled to it from the car that hit you. Even if that car didn’t do anything wrong or somebody jumped outside the side of the street and hit your car, you’re still entitled to those benefits. Again, the triggering of these benefits isn’t going to affect your insurance rates one way or the other.

If for some reason you’re either in a car that doesn’t have these benefits or you’re struck by a car that didn’t have these benefits, pretty much every everybody in Massachusetts is able to get the benefits um one way or another, whether it’s from a car you own and that you’re not in, a family member’s car that that you weren’t in, or even as a last resort there’s a there’s a state pool that’ll pay these benefits to Massachusetts residents.

In terms of the details, the most you’re eligible for is $8,000.00 and you’re eligible for essentially three things: medical bills, lost wages, and replacement services. I’ll take those in reverse order because of the level of complication.

Replacement services aren’t something that we see very often. That is if you need to hire a nanny because you can’t watch the kids or something like that because of an injury. In reality medical expenses and these other things have gone up in terms of how much they cost, there isn’t much money available for it anymore.

For lost wages, you’re eligible for 75% of your average wage for any time you’re out because of an injury. In order to get that, first you’re going to need a note from your doctor. Secondly you’re not going to be able to get this benefit if you take sick time or vacation time or any type of paid time off. If you do end up taking PTO (“paid time off”) and your company, a lot of larger companies have this it’s called a vacation buyback program, the insurance company can buy your vacation back using this $8,000.00 to put you in the same place you were beforehand.

Last iis medical bills. How medical bills are paid is really dependent on what type of health insurance you have. Since everybody has some sort of health insurance it’s more complicated now than it was when then when the benefit was first put in place back in the day. If either you don’t have insurance or you have some sort of government benefits such as Mass Health or Medicare, the car insurance will pay the first $8,000.00 worth of your medical bills. Then after that it’ll it’ll fall to whatever insurance you do have whether it’s Mass Health, Medicare, or something like that.

On the other hand, if you have private health insurance through your job or something you buy on a on an exchange somewhere, the car insurance is going to pay the first $2,000.00 worth of your medical bills. After that it’ll fall to your health insurance. But if there’s anything your health insurance doesn’t pay like co-pays, deductibles, co-insurance, or anything like that, it’ll go back to the car insurance up to a total of $8,000.00. So if you go to see your primary care doctor and there’s a $20.00 copay, you’ll pay it out of pocket there and then the car insurance will reimburse you afterwards. There’s no out-of-pocket loss.

The most important thing to remember in that is what we tell all our clients is that some health insurance companies make you jump through hoops to get treatment. Whether it’s networks, deductibles, stuff like that. You just gotta make sure you follow whatever rules your health insurance has in order to get your treatment. Just so the health insurance will pay if it needs to.

That’s a basic overview of personal injury protection benefits. If you’re in a car accident and you have questions about who’s going to pay your medical bills, it can be very confusing. Sometimes you don’t necessarily trust what the insurance companies say to you. If you have any questions about this or any other legal topic, feel free to give me a call or send an email to us at www.marcottelawfirm.com. We are happy to answer any questions you have whether you have a case with us or not.

Hopefully you don’t find yourself in a place where you’re trying to figure out how your medical bills are going to get paid because that means you were injured, but hopefully this video answers some of your questions. Thanks