In Massachusetts, most motorists or pedestrians involved in a car accident enjoy certain “No Fault” benefits. These benefits can pay up to $8,000 in lost wages and/or medical bills, regardless of who was at fault for the accident. In addition, “Med Pay” coverage is a form of motor vehicle insurance coverage that can be used to pay for expenses incurred for medical treatment. In Golchin v. Liberty Mutual Insurance Company, the Supreme Judicial Court held that an insurer must pay benefits available under “Med Pay” even if the insured has had the cost of treatments paid for by his or her health insurance policy. This ruling will likely have a big impact on motor vehicle personal injury cases.
Diane Golchin was seriously injured in an automobile accident and incurred in excess of $100,000 in medical bills. Her health insurer, Blue Cross/Blue Shield, paid for her bills under a policy she held with the company. Blue Cross thereafter asserted a lien against Ms. Golchin’s personal injury claim in the amount of $32,033.03, the amount it actually paid for the treatments she required. Golchin then applied for the $25,000 in Med Pay benefits available under the automobile policy her husband had with Liberty. Liberty refused to provide those benefits because the bills were already paid by Blue Cross. Liberty claimed that Med Pay benefits were to cover expenses “incurred” as a result of an accident and because Golchin had those expenses paid by Blue Cross, the coverage did not apply. Golchin sued Liberty Mutual over this dispute and a Superior Court judge ruled in Liberty’s favor. On appeal, the SJC reversed the lower court’s ruling and found that Med Pay coverage is available even when another insurer has paid the bills for treatment.
The SJC rejected Liberty Mutual’s argument that Med Pay does not apply to situations in which the insured has expenses paid for by another insurance company. Because the coverage would only trigger whenever an insured “incurred” expenses, Liberty Mutual argued that having another insurer pay for those expenses meant that the insured did not and never could have incurred the expenses for which she sought coverage under the Med Pay provision. Liberty Mutual also argued that certain regulations issued by the Commissioner of Insurance prohibited payment except for deductibles, co-payments, or co-insurance. Thus, Liberty Mutual claimed it would only have to pay in circumstances where a personal injury claimant incurred co-payments, deductibles, or co-insurance. The SJC flatly rejected this claim and found that nothing in the Med Pay policy language supported Liberty Mutual’s position. More importantly, the SJC found that Blue Cross had asserted a lien for the payments it had made to Ms. Golchin’s medical providers and that the lien represented “expenses incurred” as a result of the accident. It reasoned that the Med Pay coverage would be available to offset these expenses and avoid the “double recovery” complained of by Liberty Mutual.
SUGARMAN attorneys have an extensive history of representing clients who have been injured in motor vehicle accidents. If you have been hurt in an accident and wish to speak to one of our attorneys regarding liability, please fill out a Contact Form, call us at (617) 542-1000 or e-mail firstname.lastname@example.org.