Massachusetts Court Rules Personal Injury Protection Benefits Determination Includes Exams by Physical Therapists

6104068209_d134b246f5_b-300x200Massachusetts is one of 17 states that require motorists to obtain Personal Injury Protection (PIP) coverage as part of their auto insurance coverage policies. The benefits provided under PIP are called no-fault insurance coverage, meaning that you have a right to make a claim with your insurer to receive PIP benefits after you have been involved in an accident, whether or not you were at fault. Many injured motorists file a claim for PIP benefits to cover their medical expenses following a collision, which can become incredibly expensive.

In the recent case of Ortiz v. Examworks, Inc., the plaintiff suffered injuries as a passenger in a vehicle. The owner of the vehicle owned an insurance policy through Progressive Insurance. The injured passenger filed a claim with the insurance company, seeking payment of PIP benefits. According to Massachusetts law, whenever a claimant seeks payment of PIP benefits, the claimant must undergo an examination by an independent medical examiner. Accordingly, the insurance company contacted the defendant driver’s insurer to arrange for an independent medical examination, or IME. The defendant’s insurance company arranged the appointment with a physical therapist instead of a medical doctor.

The injured passenger initiated a putative class action lawsuit against the defendant on behalf of himself and other accident victims who had received IMEs with physical therapists as opposed to medical doctors. The plaintiff argued that an IME conducted for the purpose of obtaining PIP benefits could not be conducted by a physical therapist and that a medical doctor was needed to perform the examination.

The insurance company filed a motion to dismiss the complaint for failure to state a claim, and the trial court judge granted the motion. The lower court also concluded that the plaintiff’s complaint must be dismissed because it failed to allege the damages that the plaintiff or putative class would suffer as a result of the defendant’s alleged deceptive or unfair practices.

On its own motion, the trial court transferred the case to the intermediate court of appeals. In reviewing the parties’ arguments, the court noted that the Massachusetts statute requiring an IME before payment of PIP benefits did not define the term “physicians” in the context of the statute. Giving the term its usual and expected meaning, the court concluded that the statute’s reference to physicians included physical therapists. Ultimately, the court concluded that the term “physicians” as used in the PIP statute “encompasses not only medical doctors licensed under G.L. c. 112, § 2, but also other appropriate licensed or registered health care practitioners, including physical therapists licensed under G.L. c. 112, § 23B.”

If you or someone you love has been injured in a car accident, the experienced personal injury lawyers at The Law Offices of John S. Moffa can help. Our team of dedicated and experienced legal professionals knows just how stressful this time can be for you and your family. We have counseled many accident victims throughout Massachusetts and are ready to help you aggressively seek the compensation that you deserve. Call us now at 1-866-476-0828 or contact us online to set up a free consultation today.

Related Posts