What is a “no-fault” auto insurance?
If you’re involved in a motor vehicle accident, be aware that Massachusetts is a “no fault” auto insurance state. This term can be confusing, but “no fault” coverage applies only in the context of the payment of medical bills. What that means is that it doesn’t matter who was at fault for the accident – if you or a passenger in your vehicle were injured, the insurance company of the car you were in is primarily responsible for your reasonable medical bills, regardless of the facts of how the accident occurred. These are paid for under the personal injury protection part of the insurance contract.
Auto Insurance and Private Health Insurance Payments
There are many rules and regulations to follow in Massachusetts to make sure that your medical bills are taken care of by the proper insurance companies. To put it as simply as possible, the first $2,000 of the “reasonable and necessary” medical bills related to the car accident are paid for by the insurance company of the car you were in at the time of the collision. Thereafter, if you have private health insurance (Blue Cross/Blue Shield, Tufts, Harvard Pilgrim, etc.) the health insurance company pays the bills. Whatever the private health insurance company doesn’t pay, e.g., co-pays, then the auto insurance company pays up to a total of $8,000.
When you have health insurance, it’s very important that you receive medical treatment from a medical provider or medical facility that accepts your health insurance coverage. If you don’t go to a provider who accepts your health insurance (if you treat “out of network”), your auto insurance company will not pay your medical bills. You will be stuck having to pay for them yourself.
When you don’t have health insurance, or you have government-funded health insurance like MassHealth, Medicare, or Medicaid, your auto insurance company will pay up to $8,000 of personal injury protection benefits for reasonable and necessary medical treatment. You should be aware, however, that if you do have government-funded health insurance, you will be required to pay back a portion of any judgment or settlement to the government.
Your auto insurance company is also responsible for paying for lost wages accumulated as a result of the accident. The insurance company will require a letter from your doctor or medical treatment provider stating that you cannot work. You will also need documentation, such as tax returns, wage statements, or pay stubs to show that you were either working or were capable of working but couldn’t due to the accident. Once that is properly documented, the insurance company will pay 75% of your gross income earned for the prior 52 weeks. The insurance company is responsible for paying only up to $8,000 in lost wages.
Keep in mind that this is the same $8,000 that is available to pay for your medical bills. Therefore, it’s important to notify the insurance company (if you are going to be out of work for a long time) that you want your lost wages to be paid before any medical bills are paid. Once the insurance company pays the $8,000 to the medical providers, there will be nothing left for your lost wages.