Mike Tracy at Rudolph Friedman, has forwarded to us a decision handed recorded on May 12, 2008 from the Supreme Judicial Court of Massachusetts, upholding a clause of the health insurance contract that needs Medpay to become exhausted until the health insurer is needed to pay. Metropolitan Property and Casualty Ins. Co. v. Blue Cross and Blue Shield of Mass., Inc. (I ought to note that Mike, that is on surface of everything relating to insurance coverage issues, actually forwarded this decision to me upon the 12th. )MedPay is definitely an optional coverage of motor vehicle insurance. It isn‘t section of the PIP scheme, but provides medical coverage for an insured after PIP payments happen to be exhausted. I have not encounter MedPay issues very often. I believe the most reason is the majority of folks that have health insurance do not bother to purchase it, though it can cover health insurance copayments or any other gaps in medical insurance coverage. People that do not have health insurance, I imagine, will not purchase any optional coverages as they simply enhance the price of the auto insurance.
In Metropolitan, Rice was injured inside a motor vehicle accident. He‘d PIP and Medpay coverage with a Metropolitan auto policy and had health insurance with Blue Cross. Met paid the very first $2, 000 of his medical bills under PIP coverage. Rice submitted leftover bills to Blue Cross.
Blue Cross denied coverage upon the grounds that its subscriber certificate stated, " Unless required by law, coverage under this contract will certainly be secondary when another plan defined elsewhere to incorporate MedPay coverage provides you with coverage for healthcare services. " Metropolitan brought a declaratory judgment action, seeking a declaration that it was eventually not obligated to supply medical benefits to Rice after his PIP coverage was exhausted.
The SJC noted that by statute a health insurer might not deny coverage due to the existence of PIP benefits, however that no statute prohibits a health insurer from denying coverage due to the existence of MedPay benefits.
The SJC rejected Met's argument that in case health insurance wouldn‘t cover the extra medical bills, Met would cover it under PIP, not MedPay. The SJC stated that such an action could be illogical and contrary towards the intent from the PIP statute to help keep the costs of compulsory PIP insurance low. The SJC went further and stated that each time a health insurer denies coverage due to the existence of MedPay benefits, the motor vehicle insurer must cover those medical costs under MedPay, not PIP.