PIP and Med Pay

    Posted by MAIA on May 12, 2020 8:41:56 AM

    This question was answered based upon current rules, regulations & statutes in effect on May 12, 2020
     
    QUESTION

    A client, a personal injury attorney, requested we remove $25000 of Medical Payment coverage from her auto policy because her company (Travelers) would not provide Medical payment until.....coverage was exhausted from PIP, her Personal Health policy, and then and only would they access Med Pay coverage....I thought PIP balance could be utilized for loss wages and rehabilitative services and you utilize Med Pay.....so the remaining benefits in PIP would be available.  Am I incorrect? Please let me know.

    Thank you

    ANSWER

    Irene Morrill:  I know that the first 2,000 of medical bills from auto IS PIP …but after that it is health insurance …and then come back to MP Part 6

    Some people have a policy of health, sickness, or disability insurance or a contract or agreement with a group, organization partnership or corporation to provide, pay for, or reimburse the cost of medical expenses ("health plan").  If so, we will pay up to $2,000 of medical expenses for any injured person.  We will also pay medical expenses in excess of $2,000 for such injured person which will not be paid by a health plan.  Medical expenses must be submitted to the health plan to determine what the health plan will pay before we pay benefits in excess of $2,000 under this part.  We will not pay for medical expenses in excess of $2,000 that the health plan would have paid had the injured person sought treatment in accordance with the requirements of the health plan.  In any case, our total payment for medical expenses, lost wages and replacement services will not exceed $8,000.

    Our cost containment regulations “guarantees” that health insurance MUST pay before MP …and MP can apply to removal of scarring and things that health insurance doesn’t …including funeral

    See attached regulation and highlighted portion

    This document is not a legal opinion and should not be relied upon as such. The intent of this document is to provide a general background regarding the topic or topics discussed, not to provide legal advice. Producers and agencies should consult an attorney regarding specific situations and specific questions with respect to the topic or topics covered in this document. Neither the Massachusetts Association of Insurance Agents, Number One Insurance Agency nor any of its employees shall be responsible for any errors or omissions regarding any statements made in this document, nor any errors or omissions regarding any statutes, regulations, court rules, and/or any other government documents cited in this document.

    Topics: Registry, 2020

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