Massachusetts Personal Injury Protection (PIP) Benefits Can Require Examination by Physical Therapists, Not Just Medical Doctors – Ortiz v. Examworks, Inc.

Many motorists count on the personal injury protection (PIP) provisions of their no-fault automobile insurance policies to pay their medical bills in the event of an accident. However, it is important to note that payment of medical expenses under PIP comes with strings attached. If you have been involved in an accident, you need to know about a recent case interpreting the statute under which PIP protection is offered.

Mass. Gen. Laws ch. 90 § 34M states that a person who seeks benefits under PIP “shall submit to physical examinations by physicians selected by the insurer as may be reasonably required.” The purported purpose of this is to assist the insurance company in determining the amount legitimately due to the claimant under the PIP provisions. In the recent case of Ortiz v. Examworks, Inc., the Massachusetts Supreme Court was called upon to interpret the statutory provisions.

The Facts of the Case

The plaintiff was a man who was injured while riding in a car insured by Progressive Insurance Company in June 2011. The man sought PIP benefits from Progressive, and Progressive contacted defendant Examworks, Inc. to arrange for an independent medical examination (IME) for the man. The defendant set up a physical therapy medical evaluation for the man with an “examining physician,” who, as it turned out, was a licensed physical therapist, not a medical doctor.

Proceedings in the Lower Court

Apparently displeased with the physical therapist’s IME, the man filed a putative class action lawsuit on behalf of himself and others who had gone through IMEs scheduled by the defendant and conducted by someone other than a licensed medical doctor. He sought declaratory relief, equitable relief, and damages. According to the man’s complaint, the IMEs were in violation of Mass. Gen. Laws ch. 112 § 8A, ch. 93A §§ 2 and 9, and ch. 214 § 1B. Although the trial court agreed with the man that Mass. Gen. Laws ch. 90 § 34M’s reference to “physicians” means licensed medical doctors, it dismissed his case for failure to state a claim because he did not sufficiently allege a claim of invasion of privacy and failed to allege an injury resulting from the defendant’s alleged unfair or deceptive practices.

The Court’s Decision on Appeal

After transferring the case from the intermediate court of appeals on its own motion, the court affirmed. Phrasing the issue as whether the word “physicians” refers solely to medical doctors licensed under Mass. Gen. Laws ch. 112 § 2 or whether the term also includes additional types of licensed health care practitioners, the court ruled that the statute was to receive the broader definition. According to the court, “physicians” includes other appropriate licensed or registered health care practitioners, such as the physical therapist who performed the man’s IME.

To Speak to a Cape Cod Car Accident Lawyer

If you have been hurt in an automobile accident and need to speak with an experienced injury attorney, the Law Offices of John C. Manoog, III welcomes the opportunity to serve you. We are well-versed in the procedures necessary to file a claim against a negligent driver, negotiate with insurance companies, and take a case to trial if necessary. You can schedule an appointment with one of our knowledgeable attorneys by calling (888) 262-6664. We accept cases throughout the Cape Cod area, including Plymouth and Hyannis. Nos falamos Portugues!

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