How Does PIP (Personal Injury Protection) Work After a Car Accident?

Policyholders pay their insurance premiums so money is available if and when they need it. If your home is damaged in a tornado, your homeowner’s insurance will help you repair it. If you have automotive insurance, you will have money available following a car accident. If you need a surgical procedure, your health insurance helps cover those costs.

Part of your auto coverage is personal injury protection, or PIP. PIP insurance is required for all motor vehicles in the state of Massachusetts, except for public transit vehicles. You cannot buy car insurance without PIP, though you can exclude yourself and your family members from the coverage.

Let’s look at how PIP benefits work and what you can do if your payments run out.

What do PIP benefits cover in Massachusetts?

PIP coverage follows the insurance policyholder in Massachusetts. However, PIP covers more than just the policyholders themselves. They also protect any other occupants who were in the vehicle during the accident. It also protects pedestrians and bicycle riders. It even covers accidents for operators outside the car, such as when they are unloading the trunk and hurt themselves.

PIP can pay for the doctor visits and medical expenses of any eligible claimant. This includes any bills for rehabilitation stays or sessions. Transport in an ambulance or other emergency vehicle is also covered by the PIP policy.

PIP also extends to wages and income that have been lost due to injuries from the accident. The amount of the payout is equal to a maximum of 75% of your weekly wages. If someone dies because of the accident, PIP benefits can cover their funeral and burial expenses, too.

PIP also covers expenses related to household chores you can no longer perform. This includes anything you now have to farm out, like childcare, maid services, lawn-care services, and even snow removal. You may hear these things referred to as “replacement services.” Family members of the insured are not considered to be eligible replacement services workers.

How much does PIP pay out?

PIP coverage will pay up to a limit of $8,000 total for medical costs, lost wages, and replacement services. If you have a deductible, it also counts toward your overall PIP total. However, if you have medical insurance, then under Massachusetts law you must submit any bills in excess of $2,000 to your medical coverage provider. (Exceptions apply for ERISA plans and for folks without health insurance, and for people on MassHealth or Medicare.)

How long can I collect PIP in Massachusetts?

PIP benefits can be paid out up to two years after the date of the car crash. Your benefits will max out before two years if you hit the $8,000 cap first.

Does fault play a role in PIP benefits?

The simple answer is no. Since PIP is no-fault coverage, it doesn’t matter if the policyholder was technically responsible for the accident. Even if they were driving distracted, driving aggressively, or exceeding the posted speed limit, they can still apply for PIP benefits.

Likewise, it doesn’t matter if the third party is the one who is technically responsible for the accident. This may be good news if it turns out that the third party did not actually have any insurance. The policyholder’s own PIP will still cover them. The purpose of the no-fault PIP is to speed up the process and avoid red tape. It does not mean, however, that the insurance company will not raise an individual’s insurance costs depending on the details of the accident. The agent may make the call to increase a member’s premium based on their behavior behind the wheel.

Who is eligible for PIP benefits?

In addition to the driver and any of their passengers, any pedestrian who is struck by the insured motor vehicle is also eligible for PIP benefits in Massachusetts. There are, however, some instances when PIP benefits do not apply.

PIP benefits do not cover a motorcyclist or motorbike rider who is hit and injured. A recent change in Massachusetts law now applies this exception to electric bicycles, which are considered motor vehicles for the purposes of PIP. PIP benefits are also voided if the injured party is under the influence of drugs or alcohol. If anyone is actively committing a felony at the time of the accident, PIP benefits no longer cover them. Felonies in Massachusetts include child endangerment, kidnapping, and sexual assault.

How are PIP benefits paid out?

In order to get your PIP benefits, you should keep track of all medical bills and services. You will need this information and other basic details about the accident in order to file an application for PIP benefits with the insurance company. Once you have filed, the insurance provider is required to pay your benefits to you in a “prompt and reasonable” amount of time. It usually takes about 30 days or less to receive payment. You may be able to file a “bad faith” claim against a company that exceeds a reasonable amount of time for a benefits distribution or if they fail to make full payments to your medical providers.

Some insurance companies may still send your benefits in the mail as a physical check. Most companies are increasingly moving to electronic fund transfers (EFTs), or direct deposits. EFTs save time and money and are more convenient for tech-savvy customers who know their way around a mobile app.

Can you get an extension on PIP payments?

No, you cannot get an extension on your PIP payments. PIP coverage stops at either the $8,000 cap or the two-year limit. If your injuries are ongoing and extreme, though, you may be able to sue for additional damages. This option is for people who are permanently disfigured, have significant medical costs, or are no longer able to work due to the severity of the accident and their subsequent physical injuries.

You can also sue for pain and suffering to compensate for other mental injuries such as depression, PTSD, or debilitating anxiety. Hiring an experienced car accident lawyer is your best bet to winning your case. The attorneys at Breakstone, White & Gluck have already won millions of dollars for their clients who have been in vehicular accidents.

What happens when PIP runs out?

If you have health insurance, that policy will cover your care. You may also use your auto insurance policy if you need to, though you’ll get a better deal using your health insurance.

But once your PIP coverage hits the $8,000 cap, then you are on your own for all additional expenses. This is why you should speak with our Boston-based car accident attorneys if you suffered an injury in a crash. Making a PIP claim does not foreclose a claim for bodily injuries. If your injuries were caused by the negligence of another person, you should promptly seed representation by a qualified Massachusetts personal injury attorney.

Breakstone, White & Gluck has helped countless people in Boston and throughout Massachusetts recover compensation for their outstanding medical bills, lost wages, and pain and suffering. Some of those awards include:

• $7.1 million for a pedestrian run over by a bus
• $3.75 million for a motorcycle operator hit by a car
• $3 million for a driver who was hit by a truck
• $2.2 million for a man who was rear-ended in rush hour traffic

A lawsuit must be filed within three years of the accident, so you should act promptly.

If you sustained life-altering injuries in a car accident, PIP can help – but it won’t be enough. Breakstone, White & Gluck is here to help you. Call our Boston injury attorneys or contact us today for a free case review.