In the Commonwealth of Massachusetts, according to G.L. c. 90, §34A, auto insurers must provide their insureds with $8K personal injury protection (PIP).  In addition, insureds may purchase optional medical payments coverage (MPC) on top of the PIP.

The law also states that the auto insurer is only responsible to pay $2K of the $8K PIP towards medical expenses arising from an automobile accident when and if the insured has health insurance.  This rule was later clarified to mean only fully funded health insurers (coming within the purview of state law) are saddled with bills beyond the first $2K.  Self-funded plans coming within the purview of ERISA will only be responsible for medical expenses after the entire $8K mandatory PIP is exhausted.

That being said, on May 12, 2008 the Supreme Judicial Court of Massachusetts held in Metropolitan Property and Casualty Insurance Company v. Blue Cross and Blue Shield of Massachusetts, Inc., 451 Mass. 389 (2008), that any insurer – fully funded or self funded – may require that that auto insurer exhaust optional MPC, if purchased by the insured, before the health insurer is responsible to begin processing bills.  This is because there is no statute or precedent prohibiting such coordination of benefits (COB), and as such, so long as the health plan includes appropriate provisions in its COB language (in its plan or policy), it may defer to said optional MPC.

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This entry was posted by Adam V. Russo on Monday, August 4th, 2008 at 4:14 pm and is filed under Massachusetts. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.