Massachusetts Appeals Court Reverses Summary Judgment in PIP Case, Sending Case Back to Trial Court for Resolution of Factual Issues Concerning Alcohol Usage

In a Cape Cod car accident case, one or both parties may initially seek payment of “personal injury protection” benefits from his or her insurance company. Ideally, these benefits are available immediately after the accident, regardless of fault. However, complications can arise, and not every driver receives the benefits to which he or she is entitled – at least not without a fight.

Facts of the Case

The plaintiff in a recent case was a medical services provider that sought to recover unpaid personal injury protection (PIP) benefits, which it alleged the defendant insurance company should have paid on behalf of a woman who was injured in a car accident. The trial court granted summary judgment to the defendant, accepting its defense that it did not owe any PIP benefits due to an exclusion in the insurance policy at issue to the effect that no benefits are to be paid when the claimant contributed to his or her own injuries through the use of alcohol. The plaintiff appealed.

Holding of the Appeals Court

The appellate court reversed, holding that the summary judgment record revealed genuine issues of material fact. The court began by pointing out that PIP benefits are standard coverage in Massachusetts and, as such, are required to be included in all car insurance policies issued in the state. PIP coverage is designed to pay the insured person’s reasonable medical expenses incurred within two years of an automobile accident. The court then acknowledged that an insurer has a right, pursuant to Massachusetts General Laws ch. 90, § 34A, to exclude injuries caused by the insured’s operation of a motor vehicle while under the influence of alcohol.

According to the court, the defendant had the burden of showing that the injured person’s use of alcohol contributed to her injuries. There was no evidence in the summary judgment record showing how the car crash in question happened, nor was there any evidence of how the injured person may have contributed to it. However, there was evidence that the injured person had a blood alcohol content above that which is defined in Massachusetts as driving under the influence. Under these circumstances, neither party was entitled to summary judgment. Instead, the appeals court ruled that there was a genuine triable issue as to whether the plaintiff’s use of alcohol actually caused the crash or contributed to her injuries. In so holding, the court noted that a witness to the accident stated that the injured person’s car “came out of nowhere” but that this was not probative of fault.

Consult an Attorney About a Cape Cod Car Accident Case

If you have been involved in a car, truck, or motorcycle accident, you should talk to an experienced Massachusetts car accident attorney about your legal rights. Even when liability seems clear, issues can arise that get in the way of fair compensation for those injured in an accident if an assertive approach is not taken. For a free consultation, call our Hyannis or Plymouth offices now at 888-262-6664.

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