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Massachusetts Supreme Judicial Court Rules Auto Accident Victim Should Have Received MedPay Coverage — Golchin v. Liberty Mutual Ins. Co.

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If you have been injured in a motor vehicle accident, you should consult with an experienced personal injury attorney soon after the accident, even if your insurance company is involved. Insurance adjusters may seem to be on your side, but their job is to minimize insurance claim. A personal injury attorney will protect your rights and get you the compensation you deserve. In a recent Supreme Judicial Court case, the plaintiff learned first hand the importance of seeking separate counsel after a car accident when her motor vehicle insurance provider denied payment of benefits.

In Golchin v. Liberty Mutual Ins. Co., Golchin was injured in an accident while riding in the passenger seat of her husband’s car. Their vehicle insurance policy, from Liberty Mutual, included a Medical Payment (MedPay) benefit of up to $25,000. Golchin also had a health insurance policy issued by the Blue Cross and Blue Shield of Massachusetts (Blue Cross). The Supreme Judicial Court of Massachusetts (SJC) ruled on whether Liberty Mutual should pay the MedPay benefit even if Blue Cross had already paid the medical expenses.

Massachusetts drivers are required to purchase Personal Injury Protection (PIP) with their vehicle insurance policies. PIP covers up to $8,000 for a medical expenses sustained in a motor vehicle accident. Insurance companies can also offer an optional MedPay coverage. MedPay covers medical expenses not covered in the PIP coverage and can be any amount stipulated in the vehicle insurance policy.

For Golchin’s injuries, Liberty Mutual paid the $8,000 in PIP coverage. Blue Cross paid the medical expenses in the amount of $32,033.03. In a civil action, Golchin received $32,033.03 from the tortfeasor, which Blue Cross had a lien on for the medical expenses they paid Golchin. Golchin requested the MedPay amount from Liberty Mutual to cover the lien, but Liberty Mutual declined payment due to Blue Cross already having paid the medical expenses.

Golchin brought a breach of contract law suit against Liberty Mutual for failure to pay the MedPay benefits in the insurance policy. Liberty Mutual brought a motion to dismiss the case stating that Blue Cross had already paid the medical expenses, and on summary judgment the Superior Court agreed and dismissed the case. The plaintiff appealed, and the SJC, analyzing the insurance policy by its plain meaning, held that Liberty Mutual could not avoid the MedPay disbursement.

The policy provided that, “we will pay reasonable expenses for necessary medical and funeral services incurred as a result of an accident.” Liberty mutual had argued that “incurred” expense included only expenses not covered by health insurance coverage or where health insurance coverage had been denied. Examining the policy under a plain meaning analysis, the court found that an objectively reasonable policy holder would read this as Liberty Mutual paying for the medical expenses incurred regardless of whether the health insurance provider, the claimant, or any third party paid the medical costs.

Moreover, the court noted that the policy did not expressly exclude the MedPay benefit when paid by the health insurance provider. This was buttressed by the fact that the policy did expressly exclude payments that were covered by the PIP portion of the plan or another vehicle insurance policy. Because of the inclusion of the PIP payments and alternative vehicle insurance policy, the court found a objectively reasonable policy holder would conclude that the policy did not bar the MedPay benefit when expenses had been paid by a health insurance provider.

This ruling protects consumers that wish to purchase multiple insurance policies when they want double coverage. Consumers should be allowed to buy extra insurance contracts and recover on both as long as they pay for both and the policy does not stipulate an exclusion. If the contract does not explicitly exclude other insurance contracts, the consumer will pay the extra cost for the policy.

The decision helps victims in motor vehicle accident cases by allowing for MedPay benefits in excess of the total amount of medical costs. Had Golchin never consulted separate counsel and merely taken the word of the insurance company, she would never have received the MedPay benefit. Furthermore, it may be a surprise to health insurance policy holders that their insurance provider can put liens on damages received through personal injury law suits. If you have been injured in a motor vehicle accident, you should consult with an experienced personal injury attorney to protect your rights and get you the compensation you deserve.

If you have suffered from a personal injury, we can ensure that you do not settle for less than the compensation you deserve. Local attorney, John C. Manoog III, has extensive experience handling cases. For a free initial consultation, call the office at 888-262-6664 or reach us by email. There is always someone available to talk to you about your case.

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