Recently, a Massachusetts Appellate Division Court affirmed a Motion to Dismiss denying personal injury protection benefits ("PIP Benefits"). The plaintiff brought a claim under G.L. c. 93A, G.L. c. 176D and alleged negligent misrepresentation.
The plaintiff alleged she was injured and unable to work due to an auto accident. As alleged, the insurance adjuster falsely told the plaintiff that the plaintiff was required to accumulate all lost wages before submitting a PIP application and the adjuster would hold the $8,000.00 and not pay her medical providers.
After complying with what the adjuster told her, the plaintiff went to submit her $8,000.00 in wages she found that the benefits had already been paid to her medical providers. As such, she did not receive any PIP benefits for her lost wages.
The court analyzing the PIP statute found that the insurer was legally obligated to pay valid PIP claims as they came in. So when the plaintiff's medical providers submitted their claims the insurer could not hold on paying out to the providers.
The PIP adjuster could not agree to violate the PIP laws and the court would not enforce an illegal contract to do so.
As to negligent misrepresentation, the court determined that the plaintiff was not damaged because her full benefits were paid to her providers and so she was not harmed in their view. And further, G.L. c. 176D and G.L. c. 93A claims could not survive for the same reasons.
What does this case teach us?
1) If an insurance adjuster lies to you in the course of adjusting your claims it may affect your benefits and there may not be any recourse. Please call us if you need advice in a personal injury matter or with personal injury protection benefits.
2) Whoever submits a valid claim to an insurer for PIP Benefits first will be protected by the PIP statute. Be first with a valid claim for PIP Benefits to secure your place in line. If you are a medical provider and need help with getting paid auto injury benefits please call.
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GRISEL ROSARIO V. AMICA MUTUAL INSURANCE COMPANY, No. 19-ADCV-154SO, 2021 WL 797942, at *1–3 (Mass. Dist. Ct. Feb. 26, 2021).
