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What You Need To Know About Filing Auto Accident Claims in a No-Fault State

Massachusetts is one of twelve states with mandatory no-fault automobile insurance. Three other states allow insurance companies to offer no-fault automobile insurance as an option.

In these states, after an accident, you will file an injury claim with your insurance company rather than the insurer for the at-fault driver. Your insurance company will not investigate the fault for the car accident when they are determining whether to pay your claim. This will speed up your processing.

Here is a guide to how to file an auto insurance claim in a no-fault state.

How No-Fault Insurance Works

Insurance companies in New York began offering no-fault auto insurance in the 1970s. Insurance rates had skyrocketed, and courts were clogged with car accident injury cases.

Under the existing fault-based auto insurance system, the driver responsible for causing an accident was liable for the injuries and property damage resulting from it. The complicated issues of causation sometimes required a judge or jury to make decisions about fault. 

As a result, the cost of insurance went up due to the legal fees involved in resolving claims. All of these cases also taxed court resources.

No-fault insurance eliminates these problems in many ways. If your injury claim falls below your no-fault policy limits, the insurance company pays the claim without regard to fault. This means the driver who caused the accident will receive benefits, just as any pedestrians, cyclists, passengers, and drivers who were not at fault will receive benefits.

What No-Fault Insurance Looks Like in Your Auto Policy

The no-fault coverage in your auto insurance policy is called personal injury protection or PIP. This coverage pays you for medical bills and lost income due to injuries received in an auto accident. PIP does not pay damages for pain and suffering.

In Massachusetts, drivers must buy $8,000 in PIP coverage. You cannot opt out of this coverage in Massachusetts. You can select a deductible amount to reduce your premiums. 

Your deductible shifts responsibility for your medical bills from the insurer to you. Thus, a $500 deductible means that you must pay $500 worth of medical bills before the insurer picks up the remaining $7,500.

Filing a No-Fault Injury Claim

A no-fault injury claim will document the nature and extent of your injuries and how you received them. You do not need to document how the accident happened because the insurer does not care about fault under a no-fault claim. You will also describe the treatment you received and any treatment that you may require in the future.

You will provide your insurer access to your medical records. You might include a copy of the accident report from the police to explain how the injuries happened. Since the insurer must pay regardless of fault, you can include the accident report even if it says you caused the accident.

Your PIP benefits cover all reasonably necessary medical expenses for your injuries. Covered expenses include costs for:

  • Medical treatment
  • Surgery
  • X-rays
  • Dental treatment
  • Physical therapy
  • Mental therapy and counseling
  • Medication
  • Ambulance transportation
  • Hospital stays
  • Prosthetic devices
  • Professional nursing

After a fatal car crash, PIP benefits include funeral expenses, as well.

Your PIP benefits also cover up to 75% of your lost income while you recover from your injuries. You will provide documentation of your wages or salary with your no-fault claim. You can include time cards or other records showing the work you missed. 

You will also provide a letter from your doctor explaining that you missed work due to medical restrictions caused by your accident.

Others Covered By Your No-Fault Policy

Your no-fault policy covers you and the others in your household, even if you were not in the car at the time. But your no-fault policy requires you to list everyone in your household that drives your vehicles. If you fail to list a driver in your household, your insurance might not cover an accident involving that driver.

Your no-fault policy also covers pedestrians and bicyclists you hit. They will file a claim with your insurer. Your insurer will pay their claims regardless of who caused the pedestrian accident or bicycle accident.

After You File a No-Fault Claim

Your insurer must either accept or deny your no-fault claim within ten days after receiving documentation of your claim. 

This does not necessarily mean that insurers resolve all claims within ten days of filing. An insurer will often request more information because the ten-day period does not begin until the insurer receives “reasonable proof” of your injuries and expenses.

When an insurer accepts your claim, it will commence payments to your medical providers within ten days. It will also reimburse you for any expenses you paid out-of-pocket and pay you for 75% of the lost income that you documented.

When an insurer denies your claim, it will provide you with the contact information for the claims adjuster who was responsible for the claim denial. 

Some reasons your insurer can properly deny PIP benefits include:

  • A vehicle was not on your policy
  • You omitted a household driver from your policy
  • You were driving under the influence of drugs or alcohol at the time of the accident
  • Your injuries were not caused by the accident
  • You were committing a felony or fleeing the police when the accident happened
  • You deliberately sought to injure yourself in the crash

If you believe the insurer improperly denied your benefits, you should consider contacting a lawyer. You may still receive your insurance benefits, but you may need help from a lawyer to document your claim and to clarify that none of the exclusions apply.

Release From the No-Fault System

Massachusetts law releases you from the no-fault system under a few circumstances:

  • You have more than $2,000 in medical expenses
  • Death
  • Loss of a body member
  • Permanent and serious disfigurement
  • Loss of sight or hearing
  • Bone fracture

In any of these cases, you can file a lawsuit against the at-fault driver and recover your economic losses, plus damages for pain and suffering. 

If you think any of these situations apply to your accident, you should consult an injury lawyer to discuss your options under the no-fault system in Massachusetts.

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