Insurance companies have no problem selling coverage to consumers, but they seem to hate living-up to their end of the bargain to consumers when they are hurt and need it the most.
The Massachusetts Supreme Judicial Court recently decided a case where an individual was injured. She incurred medical expenses which were paid by her health insurance. (See Golchin v. Liberty Mutual Insurance Company). Under usual circumstance, if you are sick or injured and need medical care, your health insurance will pay the bills and never look for you to pay them back; that’s the benefit of health insurance. However, if another person causes your need for treatment and you pursue damages from that person, your health insurer has the right to assert a lien against your recovery and get paid back for the amount they paid for your benefit.
In spite of the fact that health insurance is mandatory, by law, in Massachusetts, Automobile Insurance Companies continue to market and sell MedPay. MedPay is defined as:
“…we will pay reasonable expenses for necessary Medical Payments medical and funeral services incurred as a result of an accident. We will pay for expenses resulting from bodily injuries to anyone occupying your auto at the time of the accident. We will also pay for expenses resulting from bodily injuries to you or any household member if struck by an auto or if occupying someone else’s auto at the time of the accident.” (See Massachusetts Automobile Insurance Policy).
Getting back to Golchin, the case recently decided by the SJC, the injured person had to pay-back her health insurance approximately $32,000.00 from the damages she obtained. Luckily, she had purchased MedPay coverage in the amount of $25,000. So she requested payment from MedPay to cover the amount she paid-back to her health insurance. This seems like a simple enough request, especially since her insurance company marketed and sold her the insurance coverage. Unfortunately, her insurance company denied her claim.
The SJC stated,
“The terms ‘incur’ and ‘expenses’ are not defined in the auto policy. However, the plain meaning of the word ‘incur’ is ‘[to] sustain,’ and the word ‘expense’ is defined as ‘[a]n expenditure of money’ or ‘a cost.’ American Heritage Dictionary of the English Language 625, 889 (4th ed. 2000). The auto policy thus requires only that there be expenses for medical services sustained as a result of bodily injuries suffered in an accident by the owner of the insured vehicle or an occupant of that vehicle; it does not say who must actually pay these expenses in order to trigger the MedPay coverage under Part 6. We read this policy language to mean that MedPay is 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 pays those expenses. We conclude that this interpretation also represents ‘what an objectively reasonable insured, reading the relevant policy language, would expect to be covered.’ Golchin I, 460 Mass. at 225, quoting Given v. Commerce Ins. Co., 440 Mass. at 209.”(See Golchin v. Liberty Mutual Insurance Company).
We can chalk-this-one-up as a win for Massachusetts consumers, but it should serve as a reminder to everybody that insurance companies are not your friends. They will sell you protection and do everything in their power to prevent having to provide the protection when you need it most.
Andrew T. Silvia, Esq. and the attorneys at the Law Offices of Morgan & Murphy, LLP have years of experience handling similar cases and are always ready to help people and families rebuild their lives. If you or a loved one were injured, you should consult with an attorney as soon as possible.
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