Insurance PIP Massachusetts Lawyers Weekly

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Where a defendant insurance company was ordered to pay personal injury protection (PIP) payments for the full amount that a plaintiff hospital billed for medical services it rendered, that was error, as the hospital had previously agreed with a third party to accept only 95 percent of its billed charges.

“The defendant, Commerce Insurance Company (Commerce), appeals from (1) two decisions of the Appellate Division of the District Court that ordered summary judgment on liability for the plaintiff, Mount Auburn Hospital (MAH); and (2) two resulting money judgments that, on remand, the District Court entered in MAH’s favor against Commerce. MAH brought the claims at issue under G.L.c. 90, §34M, to recover personal injury protection (PIP) payments for the full amount MAH billed for medical services it rendered to two of Commerce’s insureds. MAH had previously entered into an agreement with a third party under which MAH agreed to accept only ninety-five percent of its billed charges as full payment for its provision of certain covered services. The Appellate Division concluded, however, that MAH’s agreement and related contracts do not relieve Commerce of its obligation to pay one hundred percent of MAH’s charges for the services rendered to Commerce’s insureds. We conclude otherwise: MAH’s agreement bound it to accept ninety-five percent payment from Commerce. We therefore reverse. …

“The decisions and orders of the Appellate Division are vacated. The judgments of the District Court are reversed and new judgments shall enter for Commerce Insurance Company on all claims.”

Mount Auburn Hospital v. Commerce Insurance Company (Lawyers Weekly No. 81-029-25) (19 pages) (Docket No. 24-P-420) (March 3, 2025).

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