![]() ![]() With coverage for health care services." Because the Metropolitan automobile policy covering Rice included $10,000 of optional MedPay benefits, Blue Cross refused to pay Rice's medical bills. Blue Cross denied coverage, however, citing a clause in its subscriber certificate that provided in relevant part, "nless otherwise required by law, coverage under this contract will be secondary when another plan provides you Metropolitan paid the first $2,000 in medical expenses pursuant to the PIP coverage in its policy, and then informed Rice that he should submit the balance of his medical bills to Blue Cross for payment. Rice received medical treatment for his injuries (from a provider within his Blue Cross network) and submitted the bills, which amounted to $5,266, to Metropolitan for payment. Rice was also covered by a health insurance policy issued by the defendant, Blue Cross and Blue Shield of Massachusetts, Inc. In May, 2002, Bernard Rice was injured in an automobile accident while he was a passenger in a motor vehicle insured by the plaintiff, Metropolitan Property and Casualty Insurance Company (Metropolitan). The summary judgment record reflects the following undisputed facts. Because we find nothing in § 34A or any other statute to prohibit a health insurer from deferring due to the existence of MedPay, we affirm the decision of the Superior Court granting summary judgment for the defendant health insurer. They part company, however, in answering the question at the heart of this case: whether a health insurer may defer coverage of medical costs above $2,000 where the insured has purchased, as part of his automobile policy, optional medical payment (MedPay) benefits. ![]() 90, § 34A (defining "ersonal injury protection"), the first $2,000 in medical costs are to be paid out of the personal injury protection (PIP) benefits available under the mandatory provisions of the automobile insurance policy. This case involves a dispute between a motor vehicle insurer and a health insurer over which company should pay for the medical treatment of a common insured who was injured in an automobile accident. Sarah Messina for Massachusetts Association of Health Plans.īOTSFORD, J. McDonough for Property Casualty Insurers Association of America. The following submitted briefs for amici curiae: The Supreme Judicial Court on its own initiative transferred the case from the Appeals Court. Henry, J., on motions for summary judgment. ĬIVIL ACTION commenced in the Superior Court Department on February 4, 2005. 34A, prohibited the insurer from deferring coverage due to the insured's purchase of optional medical payment benefits as part of his automobile insurance policy. In an action in Superior Court between a motor vehicle insurer andĪ health insurer over which should pay for the medical treatment of a common insured who had been injured in an automobile accident, the judge did not err in granting summary judgment in favor of the defendant health insurer, where nothing in the applicable coordination of benefits statute, G. Statute,ĭiscussion of the statutory framework in Massachusetts providingįor the coordination of benefits between automobile and health insurers for medical expenses arising from injuries sustained by a common insured, and discussion of the statutory provisions requiring automobile insurers to offer optional medical, or "MedPay," benefits. Insurance, Motor vehicle personal injury protection benefits, Health andĪccident, No-fault insurance, Coordination-of-benefits clause. Present: MARSHALL, C.J., GREANEY, IRELAND, SPINA, COWIN, CORDY, & BOTSFORD, JJ. BLUE CROSS AND BLUE SHIELD OF MASSACHUSETTS, INC. METROPOLITAN PROPERTY AND CASUALTY INSURANCE COMPANY vs. ![]()
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