Massachusetts Personal Injury Protection and Uninsured Motorist Coverage

This chapter covers two of the four compulsory Massachusetts auto coverages in detail: personal injury protection (PIP), the no-fault benefit, and uninsured motorist coverage, with the optional underinsured motorist coverage. The previous chapter covered the compulsory policy, its minimum limits and the residual market plan.

Personal injury protection (Mass. Gen. Laws ch. 90, §§ 34A, 34M)

PIP pays without regard to fault, to a limit of at least $8,000 on account of injury to or death of any one person (Mass. Gen. Laws ch. 90, § 34A).

Who is covered. PIP pays the named insured, members of the insured’s household, any authorized operator or passenger of the insured vehicle (including a guest occupant) and any pedestrian struck by it, unless the person is entitled to workers’ compensation (Mass. Gen. Laws ch. 90, § 34A). A “pedestrian” includes people riding bicycles, tricycles and similar vehicles and people on horseback or in horse-drawn vehicles (§ 34A). PIP also pays the named insured and household members injured while in, or struck as pedestrians by, a vehicle not insured for PIP, unless they recover those expenses in a tort suit (§ 34A).

The benefits, all within the per-person limit (Mass. Gen. Laws ch. 90, § 34A):

Medical

All reasonable expenses incurred within two years from the date of the accident for necessary medical, surgical, x-ray and dental services, including prosthetic devices and necessary ambulance, hospital, professional nursing and funeral services.

Coordination with health insurance. PIP pays no more than $2,000 of those medical expenses to the extent they have been or will be paid by health insurance. A health insurer may not deny coverage because PIP exists, and it may not recover from, or be subrogated against, the claimant for more than $2,000 of PIP benefits (Mass. Gen. Laws ch. 90, § 34A).

For example, a driver whose health plan covers her medical bills runs up $6,000 of them. PIP pays no more than $2,000 of those bills, and the health plan cannot refuse to pay the rest because PIP exists.

Loss of income/Lost wages

For a person employed or self-employed at the time of the accident, PIP pays wages or salary actually lost through inability to work, but not other income, limited to 75 percent of the person’s average weekly wage for the year before the accident (counting any wage continuation payments). For a person not employed, PIP pays for loss from diminution of earning power, under the same limits: amounts actually lost, up to 75 percent of the average weekly wage for the year before the accident (Mass. Gen. Laws ch. 90, § 34A).

Death

PIP covers bodily injury, sickness or disease caused by accident, including death at any time resulting from it (Mass. Gen. Laws ch. 90, § 34A). The statute provides no separate death benefit: the $8,000 limit applies to injury to or death of any one person.

Funeral

Funeral services are among the expenses PIP pays, on the same list as medical services and within the same limit (Mass. Gen. Laws ch. 90, § 34A).

Replacement services

PIP pays amounts actually paid to people outside the household for ordinary and necessary services the injured person would otherwise have performed, not for income, for themselves or the household, such as hiring someone to do the housework or childcare the injured person can no longer do (Mass. Gen. Laws ch. 90, § 34A).

How PIP works

• Exclusions. An insurer may exclude a person whose conduct contributed to the injury while operating a vehicle in Massachusetts: under the influence of alcohol or a narcotic drug, while committing a felony or fleeing police, or with the specific intent of causing injury or damage (Mass. Gen. Laws ch. 90, § 34A).
• Claims. A claim is presented as soon as practicable and in every case within two years of the accident (Mass. Gen. Laws ch. 90, § 34M). The injured person must submit to physical examinations by physicians the insurer selects as often as reasonably required, and noncooperation is a defense to the insurer (§ 34M).
• Payment. Benefits are payable as loss accrues. On notice of disability from a licensed physician, the insurer begins medical payments within 10 days or gives written notice of why it will not. Benefits unpaid for more than 30 days may be sued for in contract, with costs and attorney’s fees if the claimant wins (Mass. Gen. Laws ch. 90, § 34M).
• Deductibles. At the policyholder’s option, PIP may carry a deductible of $100, $250, $500, $1,000, $2,000, $4,000 or $8,000, applying to the policyholder alone or also to household members (Mass. Gen. Laws ch. 90, § 34M).
• Subrogation. A PIP insurer is subrogated to the rights of the person it pays and may sue anyone liable in tort who is not exempt. It may also claim its payments from the insurer of a Massachusetts-registered vehicle whose owner or operator would have been liable but for the exemption, by agreement or arbitration (Mass. Gen. Laws ch. 90, § 34M).
• Assigned claims plan. Insurers maintain an assigned claims plan through which a Massachusetts resident injured by a motor vehicle on a Massachusetts way, or another place the public has a right to use, can get PIP when no PIP is otherwise available. An uninsured owner or registrant and that person’s household cannot, nor can a person entitled to workers’ compensation or a person subject to a PIP exclusion (Mass. Gen. Laws ch. 90, § 34N).

The tort exemption and threshold. PIP benefits are paid in place of tort damages for an accident in Massachusetts. Owners, operators and occupants are exempt from tort liability to the extent the injured person is entitled to PIP, but not for an accident outside Massachusetts (Mass. Gen. Laws ch. 90, § 34M). Damages for pain and suffering are recoverable only if reasonable and necessary medical and related expenses exceed $2,000, unless the injury causes death, loss of a body member, permanent and serious disfigurement, the loss of sight or hearing described in ch. 152, § 36, or a fracture (Mass. Gen. Laws ch. 231, § 6D).

Uninsured/underinsured motorist (Mass. Gen. Laws ch. 175, §§ 111D, 113L)

Bodily injury

No policy may be issued for a vehicle registered in Massachusetts unless it includes uninsured motorist coverage, in the amounts prescribed for bodily injury liability. It protects insured persons legally entitled to recover damages from owners or operators of uninsured and hit-and-run vehicles because of bodily injury, sickness, disease or death. It also covers an at-fault vehicle that was insured but whose liability insurer cannot pay because of insolvency (Mass. Gen. Laws ch. 175, § 113L(1)). The coverage protects you, anyone you let drive your car, and household members and passengers who are not covered under another similar Massachusetts policy (Massachusetts Division of Insurance).

The coverage pays bodily injury only. Whether the insured is legally entitled to recover, and how much, is settled by agreement between the insured and the insurer or, if they cannot agree, by arbitration (Mass. Gen. Laws ch. 175, § 111D).

Required limits

The compulsory uninsured motorist limits are at least $25,000 per person and $50,000 for all people injured by the uninsured auto in the accident (Massachusetts Division of Insurance). An insurer must also offer additional uninsured motorist coverage of at least $15,000/$40,000 beyond the required limits, but the extra uninsured coverage chosen may not exceed the extra bodily injury coverage chosen (Mass. Gen. Laws ch. 175, § 113C).

Underinsured motorist coverage is optional. If the policyholder elects it, the coverage also applies when the at-fault vehicle is insured but its bodily injury limit is less than the policyholder’s uninsured motorist limit and too small to pay the damages, and it pays only to the extent the policyholder’s limit exceeds the at-fault driver’s limit. The policyholder must be notified of the option (Mass. Gen. Laws ch. 175, § 113L(2)). In the Division’s example, with underinsured limits of $50,000 per person, after collecting the at-fault driver’s $25,000 per-person bodily injury limit, the most you could collect from your underinsured coverage is $25,000 (Massachusetts Division of Insurance).

No stacking. Uninsured motorist limits for two or more vehicles or policies may not be added together (“stacked”). An insured who is not a named insured on any policy recovers only from the resident relative’s policy with the highest limits, whether or not the vehicle that policy insures was involved in the accident (Mass. Gen. Laws ch. 175, § 113L(5)).

Lesson summary

• PIP pays without regard to fault, up to at least $8,000 per person, to the named insured, household members, authorized operators and passengers, and pedestrians struck by the vehicle, but not to anyone entitled to workers’ compensation (ch. 90, § 34A).
• PIP pays medical and funeral expenses incurred within two years, lost wages (or diminished earning power for the unemployed) up to 75 percent of the average weekly wage and replacement services; death is covered within the same limit, with no separate death benefit (ch. 90, § 34A).
• PIP pays no more than $2,000 of medical bills that health insurance covers, and the health insurer cannot deny coverage because of PIP (ch. 90, § 34A).
• Claims are made within two years; the insurer starts medical payments within 10 days of a physician’s notice of disability or explains why not; optional deductibles run from $100 to $8,000 (ch. 90, § 34M).
• Pain and suffering damages require medical expenses over $2,000, or death, loss of a body member, permanent and serious disfigurement, listed loss of sight or hearing, or a fracture (ch. 231, § 6D).
• Uninsured motorist coverage is compulsory at $25,000/$50,000 and includes hit-and-run vehicles and insolvent insurers; disputes go to agreement or arbitration (ch. 175, §§ 111D, 113L).
• Underinsured motorist coverage is optional, pays only the amount by which your limit exceeds the at-fault driver’s, and limits do not stack (ch. 175, § 113L).