Personal Injury Protection, or PIP, is the no-fault coverage built into every Massachusetts auto policy, and it pays up to $8,000 per injured person for medical bills, lost wages, and replacement household services after a crash, no matter who was at fault. Here is how PIP works in Massachusetts: the money comes from your own auto insurer, it starts flowing before your health plan gets involved, and it covers you, your passengers, anyone driving your car with permission, and pedestrians your vehicle strikes. In exchange for that quick payout, the state limits when you can sue the other driver for pain and suffering.
What PIP Pays For
The $8,000 limit is a single pool per person, and three types of losses draw from it.1Mass.gov. Basics of Auto Insurance
- Medical expenses that are reasonable and necessary, including hospital stays, surgery, X-rays, dental work, ambulance transport, prosthetics, and professional nursing care. The treatment must be incurred within two years of the accident.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
- Lost wages at 75% of your average weekly earnings before the crash, reimbursing only what you actually lost because of the injury.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
- Replacement services for household tasks you used to do yourself, such as cleaning, yard work, or child care. The person you hire cannot live in your household.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
All three categories share the same $8,000 cap. If your medical bills eat $6,000, only $2,000 is left for wages and household help combined. People who were not working at the time of the crash can claim for diminished earning power instead of lost wages, plus replacement services.
Who Is Covered
PIP follows the policy and the vehicle, not just the person who paid the premium. Covered people include:2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
- You and every member of your household, whether in your car, in another car, or struck as a pedestrian.
- Anyone driving your car with your permission, and every passenger in it, including guests.
- Pedestrians hit by your insured vehicle, even if they have no auto insurance and no driver’s license.
Each injured person gets their own $8,000 limit. Three injured passengers in one crash means three separate $8,000 pools. One exclusion matters: if you are entitled to workers’ compensation for the same injury, PIP does not pay on top of it.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
How PIP and Your Health Insurance Share the Bill
PIP is the primary payer for the first $2,000 of medical expenses. Once your bills cross that line, your private health insurer takes over as primary for additional treatment.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A
PIP does not disappear at that point. If your health plan denies a charge, or if you owe copays and deductibles, PIP keeps paying those gaps until the $8,000 cap is used up. For most people with standard health coverage, PIP handles the first $2,000, then returns to fill holes the health plan leaves behind.
Self-Funded ERISA Plans Work Differently
The $2,000 handoff is a state insurance rule, and self-funded employer health plans governed by federal ERISA law are not bound by it. Some ERISA plan documents make the health plan secondary to auto insurance for the full $8,000, forcing PIP to be exhausted first. Others stay silent and may share costs more readily. The outcome depends on your specific plan document, so if your health coverage is self-funded through an employer, read the plan language before assuming the usual $2,000 transition applies.3Mass.gov. Coordination of Benefits
When You Can Still Sue the At-Fault Driver
No-fault does not mean no lawsuits. Under the Massachusetts tort threshold, you can sue the driver who caused the crash for pain and suffering if your reasonable medical expenses exceed $2,000, or if your injury falls into one of five categories:4General Court of Massachusetts. Massachusetts General Laws Chapter 231, Section 6D
- Death
- Loss of a body member
- Permanent and serious disfigurement
- Loss of sight or hearing
- A fracture
Any one of those categories opens the courthouse door regardless of your bill total. Short of that, you need at least $2,000 in documented medical costs. This $2,000 figure is a separate rule from the health-insurance coordination number above; they happen to match but govern different things. One decides when your health plan starts paying, the other decides when you can sue.4General Court of Massachusetts. Massachusetts General Laws Chapter 231, Section 6D
For broken bones, scarring, or other significant harm, PIP still pays and you can also pursue a full personal injury claim against the responsible driver.
Filing the Claim
You have two years from the accident date to file a PIP claim with your auto insurer. The statute says to file “as soon as practicable” and treats two years as the absolute cutoff.5General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34M Miss it and your benefits are gone. Insurers enforce the deadline strictly.
After you report the crash, the insurer sends a PIP Application for Benefits. The form asks you to describe how the accident happened and what injuries you have. Be specific about every body part affected and every symptom. Vague answers give adjusters room to argue later that your treatment does not match what you reported.
With the application, submit the date, time, and location of the accident; contact information for every provider treating you; signed authorizations letting the insurer pull your medical records and verify your wages; your employer’s HR contact if you are claiming lost income; and copies of medical bills as they arrive. Send everything by certified mail with a return receipt so you have proof if the insurer later says it never received a document.
Once the insurer has reasonable proof of your losses, benefits are due as those losses accrue. If a licensed physician notifies the insurer of your disability, the company must either begin paying medical benefits within ten days or send written notice explaining its specific reasons for refusing.5General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34M Keep sending updated bills and wage records as treatment continues.
Independent Medical Examinations
Your insurer can require you to be examined by a doctor of its choosing, as often as it reasonably requests, at the insurer’s expense. The statute calls these physical examinations; the industry calls them IMEs.5General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34M
Attend them. Noncooperation is an explicit defense the insurer can raise against any lawsuit you later file over PIP payments, and skipping an IME is the fastest way to lose benefits you otherwise have a right to.5General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34M If the IME doctor concludes your treatment is no longer necessary and the insurer stops paying, you can push back with records from your own treating physician, request a review, or pursue the claim through litigation. Those options stay open only if you showed up.
What PIP Does Not Cover
PIP is bodily-injury coverage only. It does not pay to repair your car or replace personal property. Vehicle damage in Massachusetts follows ordinary fault rules, meaning the at-fault driver’s insurance is responsible for repairs, or you can use your own collision coverage if you carry it.1Mass.gov. Basics of Auto Insurance
PIP also excludes injuries caused intentionally rather than by accident.2General Court of Massachusetts. Massachusetts General Laws Chapter 90, Section 34A And because every covered expense must be incurred within two years of the crash, treatment you receive after that window falls outside PIP coverage even if your $8,000 is not fully used.