Personal Injury Protection benefits (commonly referred to as PIP benefits) are “no fault” benefits that provide up to $8,000 in coverage for anyone involved in a motor vehicle accident, regardless of who caused the accident. PIP benefits may be used to pay for medical expenses, replacement services, and 75% of lost wages. In order to obtain PIP benefits, an application must be filed with the insurance carrier, otherwise no payments will be issued.
Medical Expenses: The first $2,000 in PIP benefits are used exclusively for medical expenses. The amount of coverage for medical expenses is determined by what type of health insurance the injured person has. If the injured person has a private health policy (Non-ERISA funded health plan), then the injured person has at least $2,000 in medical expense coverage and possibly more depending on what bills are covered by the private health policy. If the injured person has an ERISA funded plan or a non-private health policy (Massachusetts Health, for example), then the injured person has up to $8,000 in medical expense PIP coverage.
Lost Wages: PIP benefits will cover 75% of lost wages incurred as a result of the accident. These benefits exist to the extent that the injured does not receive benefits through a disability plan.
Replacement Services: PIP benefits may be used to pay reasonable expenses to non-family members. This is designed to perform services an injured person would otherwise have performed for the benefit of himself/herself and/or family members of his/her household. Examples include child-care or cleaning services.
NOTE – PIP benefits are NOT available in the following circumstances:
Many attorneys, insurance companies, and others may try to tell you what your case is worth before they know much about it. The real answer to that question can only be answered after a thorough case analysis. This requires investigating every fact, medical bill, medical record, and most importantly, evaluating your personal story and your personal experience.
Much of the case value analysis cannot be completed until your treatment is complete or you have reached a medical end result. Quite simply, at Sweeney Merrigan Law, we create case value by developing YOUR story based on your injuries and treatment. Our goal is to maximize that value for each person we represent.
The value of a case is personal in every sense of the word.
A leg injury caused by a slip on ice to Mary Sue who lives in a downtown Boston basement rental apartment, who loves to run and swim, and works at an office desk is very different from the value of a leg injury caused by a drunk driver to Mike Smith who lives in a suburban home nestled on large piece of property, whose passion is to read when he isn’t laboring away at the construction site. These examples are used to illustrate the unique ways in which people get injured and how their injuries affect them differently.
We want to know your story.
Each of our clients has a different story involving a different set of facts, circumstances, and injuries that affect each person differently. Therefore, in order to determine how much your case is worth we must take the time to develop a personalized case management plan that is specific to you and your needs.
One of our former clients identified the personalized nature with which we approach every case when he said:
“I feel that my legal needs are important to them and that I am a person and not just a file number or court date” ~Janer, Dorchester, MA
The PIP deductible trap is one to be wary of any time you are purchasing automobile insurance. More and more insurance companies are cutting their rates to induce customers to assume the responsibility of PIP coverage. This form of self-insurance often saves the customer very little on their annual rate, while compromising some of the most important and vital coverage afforded through automobile insurance.
In basic terms, the customer agrees by contract with the insurer to self-insure the first $8,000 in medical expenses, lost wages, and replacement services. Even worse, your health insurer will often not pay a penny until the $8,000 in medical expense threshold has been reached.
Once retained, we will coordinate the payment of your medical bills, whether that is through the applicable automobile NO FAULT (PIP) insurance benefits, your health insurance, or simply by pursuing the person/entity responsible for having caused you to incur medical bills. You no longer need to stress about whether your bills will be paid. Instead, your only job is to do what you doctor tells you: get better. Forward all of your medical bills to us.
The insurance claims process involving medical expenses requires constant coordination and monitoring. Our office will be sure that any available insurance policies and benefits are applied in order to minimize your risk of out of pocket exposure.
Very often people will brag or boast that they received a large settlement or verdict at the end of a case, but those numbers are meaningless if the attorney handling the case leaves his/her client with large outstanding medical bills. As with every case we handle, we will provide a complete account for all medical expenses, with the goal that all balances will be paid in full, which maximizes the settlement/verdict value to you.
We work on our cases through a contingency fee, which typically is 33.33% of what we are able to achieve on your behalf. Therefore, the cost of hiring our attorneys to work on your case is determined by the outcome. As we say: “NO FEE UNLESS SUCCESSFUL.”
The purpose of the contingency fee is to accommodate people who are injured and would otherwise not have the means or be in a position to dig into their savings to hire an attorney. The function of the contingency fee is symbiotic — the attorney is incentivized to achieve the highest possible outcome he/she can on behalf of his/her client. Moreover, because the fee is determined by the outcome of the case, clients do not need to be concerned that when they have a question or with every phone call, text, or email they will incur an hourly attorney’s fee.
Should you have any specific questions on how a contingency fee works, please contact our office for a free consultation and take comfort knowing that you do not have to pay us to evaluate your claim.
In the days or weeks following an accident, you are not required to answer any questions from anyone. Insurance companies and the investigators they hire will work quickly to obtain your statement and encourage you to sign documents, which release your very personal information.
You are not obligated to say anything or sign anything. Remember, insurance companies are in the business of collecting monthly premiums on their policies, while paying as little as possible when claims are made. If you have been injured, you need an attorney who can protect your rights and fight your case. Talk to one of our lawyers before you talk to anyone else.
Once we become your attorneys, you can tell anyone who contacts you to call and speak to us.
The timetable of your case depends on how long it takes for you to get better. When injured, our bodies respond and heal differently and, as a result, there is no universal schedule for any one case. Our goal, however, is to move your case along as quickly as possible, while keeping you informed of every step along the way. There are different moments throughout your case where negotiations will be had and offers will likely be made – you are the decision-maker and the boss when it comes to accepting or rejecting those offers.
Although we are here to make recommendations as to whether we think they are fair or reasonable, our primary job is to prepare for trial. The court system is slow and it often takes many months before a trial date will be secured. In the meantime, should there be any offers to settle, you will be the one who ultimately decides whether to settle or continue to trial.
Yes. We will pursue any and all lost wages you have incurred as a result of your injury. Lost wages are pursued within the scope of one’s lost earning capacity. Lost earning capacity is the loss of opportunity to earn income as a result of one’s injuries. This includes both direct lost wages as well as the opportunity costs suffered by loss of employment based on one’s professional earning capacity, age, experience, industry, etc.
If you have been injured in an automobile accident, you will be able to pursue up to $6,000 in lost wage PIP benefits regardless of who was at fault for the accident. This coverage provides reimbursement for 75% compensation for your gross lost wages. In order to obtain lost wages, a doctor must provide a note documenting that your missed time from work was due to medical incapacity (rather than for things like scheduling to attend medical appointments). You will also need to provide a statement from your employer as well as prior tax returns in order to detail the amount of your lost wages. If you are self-employed, tax returns and your business accounts will be the primary method for detailing your losses.
Medical Payment (MedPay), is a form of optional coverage that allows the insured to recover “reasonable expenses for necessary medical and funeral services incurred as the result of an accident.” MedPay is not a required form of coverage (unlike PIP) and is usually sold to an insured person at an added cost. Depending on the amount of coverage elected, MedPay typically ranges from $5,000 to $25,000.
There is a dispute in the case law in Massachusetts as to when MedPay is applied. Insurance companies typically argue that it is not applicable until the full $8,000 in PIP coverage is exhausted. We, however, take the position that medical expenses not covered by PIP coverage (even when PIP is not yet exhausted) is covered by MedPay.
While insurance companies are eager to sell insurance policies affording MedPay coverage at a higher annual premium, they do seem to not fully understand the extent of the coverage they have contracted to sell. This is a sticky issue that requires precise legal argument as it pertains to a contract law and consumer protection rights afforded by Chapter 93A. Should you have a question about whether it is worth paying a higher premium for MedPay coverage or about how MedPay applies in your case, please do not hesitate to contact our office.
Although hit-and-run accidents are devastating, almost anyone who has been injured in a hit- and-run accident (who is not at fault for the accident) will be able to recover for their injuries if they own an insured vehicle or a family member that they live with does. These claims are made through what is called uninsured coverage.
Insurance is a type of contract. A contract for automobile insurance provides that the insured pays the insurance company every month and in exchange for those payments, the insurance company agrees to pay a much larger sum of money should an accident with injuries occur. Uninsured coverage is a contractual benefit that exists to cover someone who has been injured by an uninsured vehicle or a hit-and-run driver.
Uninsured coverage exists in every automobile insurance contract in Massachusetts. Therefore, if you have been injured in a hit-and-run accident and you (or a family member you live with) own(s) an insured vehicle, you will be able to pursue a claim through uninsured coverage, even if the person who hit you is never identified.
Whenever someone is injured in a car accident, it is our job to investigate all forms of insurance coverage that may be available for recovery. For that reason, make sure you don’t leave any stone unturned and call our office to see if you are eligible to make a claim. Remember, we do not charge a fee unless we are able to recover something on your behalf.