A Recent Massachusetts Appellate Opinion Highlights the Importance of Complying with Deadlines in PIP Insurance Claims

Massachusetts requires drivers to carry personal injury protection (PIP) benefits to provide coverage in the event that the driver is involved in an accident. Understanding how these benefits play out in a claim and whether you are receiving the coverage that you deserve can be difficult to determine at times. Our diligent team of Boston car accident lawyers is ready to help you assert your rights following a car accident, which includes ensuring that insurance companies are playing by the rules.

In a recent case, the plaintiff was a medical services provider that filed a lawsuit to recover unpaid PIP benefits on behalf of a woman who was injured in a car accident and who obtained medical treatment from the plaintiff. The defendant asserted the affirmative defense of noncooperation in response to the complaint.

The matter proceeded to a trial and the jury returned a verdict in favor of the defendant. The plaintiff appealed on the basis that the judge committed a reversible error in denying its motion for a directed verdict. A motion for a directed verdict asks the court to conclude that no reasonable jury could reach a finding for the other party based on the evidence presented at trial. In evaluating this motion, the court must consider the facts in the light most favorable to the moving party.

The appellate court first reviewed the evidence in the record. Sometime after the accident, an attorney sent a letter to the defendant informing it that he represented three persons who were involved in the crash and that they were making a claim for PIP benefits. Two months later, the insurer sent a letter notifying the lawyer that examinations under oath (EUO) had been scheduled for each of his clients. One of the clients, the woman injured in the accident, did not appear for the EUO. The insurer attempted to reschedule the EUO two more times, but the client failed to appear each time. The insurer sent a letter to the attorney stating that the claim for the client’s PIP benefits was denied due to noncooperation.

The appellate court was unable to find evidence in the record explaining the client’s failure to appear despite being provided with a number of opportunities during a five-month time span. The appellate court rejected the plaintiff’s argument that the client did not have notice because the letters were sent to the attorney and not to the client directly. When a person retains a lawyer, notice on the lawyer automatically constitutes notice on the client. The court also concluded that the letters were properly admitted into evidence. Based on these findings, the court upheld the denial of the motion for a directed verdict. This case highlights the importance of complying with key procedural steps in an insurance claim such as complying with deadlines. Otherwise, a party risks waiving certain rights.

If you were injured in a car accident, you deserve an attorney who will provide you with diligent and timely legal representation. As experienced motor vehicle accident trial lawyers, we have substantial experience working against insurance companies and negotiating in our clients’ best interests. To schedule your free consultation, call us at 617-263-0060 or contact us online.