Fall River Personal Injury Law Digest: Mass. PIP and MedPay Part II

The facts of Golchin v. Liberty Mutual Insurance Co., 950 N.E. 2d 853 (Mass. 2011) provide an example of how Personal Injury Protection (PIP), MedPay, and health insurance work with one another under a Massachusetts standard auto insurance policy.

In Golchin, the Plaintiff incurred over $100,000 in medical expenses after a car accident. She had health insurance coverage. The car was insured with a Massachusetts standard insurance policy, as well as $25,000 in MedPay coverage. After receiving $2,000 in PIP, she then sought her MedPay benefits from the auto insurer. The insurer refused to pay because her health insurance had already paid the expenses. The Plaintiff then brought suit against the insurer.

The Supreme Judicial Court of Massachusetts reasoned through the interplay of PIP, MedPay, and health insurance and its application to the plaintiff. The Court found that only $2,000 in PIP had been paid, and it would have dismissed the claim except for additional evidence. The Court looked at a demand letter from the Plaintiff, introduced by the Defendant that stated PIP was exhausted. The Court noted that each party cited to the letter and each lower court had relied on it in their opinions. The Court, therefore, decided that it was an agreed fact that PIP was exhausted.

Ultimately, the Court found that there was nothing that precluded the Plaintiff’s payment as a matter of law. The fact that the Plaintiff had health insurance did not preclude payment, nor did the fact that her expenses had already been paid. There is nothing in the standard MA auto insurance policy that precludes payment of MedPay benefits once PIP is exhausted. Here, because the parties agreed that PIP had been exhausted, the Plaintiff was entitled to seek MedPay benefits even if it meant she recovered twice for the same expenses.