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Auto accident victim should have received insurance medical payments

After a significant motor vehicle accident, a victim needs to concentrate on receiving the medical attention they need. Such treatment may require payment by an insurance company-under the victim’s policy or the policy of the at fault driver-but, unfortunately, insurance companies may not always be forthcoming with such payments.

The victim may even find themselves caught between insurance companies. The Massachusetts Supreme Judicial Court case of Golchin v. Liberty Mutual Insurance Company illustrates such a situation.

More than $100,000 in medical expenses

The victim in this case sustained significant personal injuries when she was involved in a motor vehicle accident as an occupant of her husband’s car. The car was insured under an automobile insurance policy which included standard “medical payments” (MedPay) coverage of up to $25,000, yet the auto insurance company paid only $8,000 in personal injury protection benefits.

At the time of the accident, the victim also was insured under a health insurance policy. The health insurance company separately paid the victim’s additional medical expenses, the charges for which came to $100,893. The victim submitted documentation to the auto insurance company seeking further coverage under the MedPay provisions of the auto policy, but the auto insurance company declined to pay.

Thereafter, the victim sued the auto insurance company for its failure to disburse the MedPay benefits. However, a Superior Court judge determined that, as a matter of law, the victim had never “incurred” any expenses for medical services within the meaning of the auto policy’s MedPay provisions because the charges had already been covered by the health insurance policy. The victim appealed this decision.

Would the auto insurance company pay?

The Supreme Judicial Court of Massachusetts noted that the terms “incur” and “expenses” were not defined in the auto policy. However, the plain meaning of the word incur is “to sustain,” and the word “expense” is defined as “an expenditure of money.” The auto policy thus required only that there be expenses for medical services sustained as a result of bodily injuries; it did not say who must actually pay these expenses in order to trigger the MedPay coverage.

The court read the policy language to mean that MedPay was intended to cover, up to the limits of coverage purchased, medical expenses resulting from injuries caused by an accident, regardless of who-whether the claimant or a health insurance provider-actually paid those expenses.

In this case, the record indicated that the personal injuries the victim sustained in her automobile accident resulted in medical expenses that were clearly “incurred” within the plain language of the auto policy. The victim was therefore is entitled to recover MedPay benefits under the auto policy in the full purchased amount of $25,000.

Seeking the compensation you deserve

In the wake of an auto accident, whether an insurance company is trying to rush you to an unfavorable settlement, or simply refusing to pay at all, you need the counsel of an experienced personal injury attorney. Seek representation by a firm who will protect your rights and ensure that you receive all the compensation to which you should be entitled for your injuries.

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