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Medical Providers Being Forced To “Jump through Hoops”

medical bills with change jarIn my previous job working at a chiropractor’s office, I would get a sort of disappointed feeling every time I answered the phone and a new personal injury patient was at the end of the other line to schedule an appointment. Not because we didn’t want to treat the patient, but more because of the back and forth that was to materialize throughout the coming days with the patient’s insurance carrier.

Recently the State District Court rendered a decision in VIP Physical Therapy, Inc. v. Government Insurance Company.  Government Insurance Company was sued by VIP Physical Therapy, Inc. under the personal injury protection statue, for refusing to pay for treatment that VIP Physical Therapy, Inc had rendered to the injured policyholders.  The defendant Government Insurance Company argued that the Massachusetts Standard Automobile Policy states that “anyone covered under [a] policy” and “any person seeking payment” must cooperate with the insurer, including submitting themselves to a EUO (Examination Under Oath) at a place designated by the insurer.  Subsequently, Government Insurance Company argued, that by refusing to submit to a EUO VIP Physical Therapy, Inc. was being uncooperative which justified their refusal to pay for rendered services.

Judge William P. Hadley disagreed with the defendant Government Insurance Company. Hadley pointed out that that the terminology in the standard automobile policy conflicts with the terminology in the PIP statue itself. Under the PIP statue it states that non-cooperation defense is limited to the non-cooperation by the “injured party.” Therefore, Hadley granted the plaintiff VIP Physical Therapy, Inc. their motion for partial summary judgment.

Many times, I have found that auto insurers make it somewhat difficult for injured parties in car accidents to obtain payment for their medical bills. In my personal experience, while working at a chiropractor’s office, this discourages medical providers to render services to the people in need of these services. This ruling gives medical providers a sense of security knowing that they can provide care to the injured parties without the concern of having to ensue in a battle with insurers over payment.

While not involved in VIP Physical Therapy, Inc. v. Government Insurance Company, Attorney Robert Mazow of Mazow & McCullough was contacted by Massachusetts Lawyers Weekly to provide insight into the opinion. “Requiring that medical providers jump through hoops and attended what are essentially depositions without boundaries puts an unfair burden on providers and their patients and stretches the PIP statue beyond the breaking point.” Mazow said. “Moreover, the PIP statue simply cannot be logically construed so as to extend the duty to provide a EUO beyond insureds and claimants.”

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