Morrison Mahoney Of Counsel Doug McInnis recently secured a defense verdict in a c. 93A and PIP suit filed by a chiropractor against our client, an auto insurer, which had exhausted PIP by paying the underlying claimant for his lost wages. The chiropractor sought treble damages and attorney fees and costs, arguing that an assignment of benefits that was secured from the claimant, at the time of his treatment, entitled it to all available PIP benefits before any other person or entity who may submit a claim.
At trial, Doug argued where an injured claimant has health insurance, the automobile insurer should be responsible for the initial $2,000 of medical expenses, with the remaining $6,000 in PIP benefits to be borne by the automobile insurer in the form of lost wages, replacement services, and additional medical expenses not covered by the health insurer. This interpretation provides the greatest coverage for the insured.
Moreover, Doug argued that our client informed the medical provider that the claimant’s $2,000 PIP benefits had been exhausted, and to coordinate benefits with his health insurer. Any denial of payment of those bills by the health insurer could then have been resubmitted to our client.
Our client, however, never received any documentation of an insurance denial by the claimant’s health insurer. Under the coordination of benefits provision of the claimant’s insurance policy, the provider had a duty to submit bills beyond the initial $2,000.00 PIP limit to his health insurer before submitting them to our client, the PIP carrier.
The court found in our client’s favor on all counts.