Wednesday, October 28, 2009

Appellate Division holds no right to PIP benefits where medical bills have been paid by Medicare and Medicaid

In Chery v. Metro. Prop. and Cas. Ins. Co., 2009 WL 3381597, an insured sought PIP payments for a medical bill of $360.63. The bill had been paid by Medicare and Medicaid prior to the insured submitting it to the PIP carrier.

The court held that the PIP carrier had no obligation to pay the bill because the PIP statute:

mandates only that PIP payments “shall be due and payable as loss accrues, upon receipt of reasonable proof of the fact and amount of expenses and loss incurred.” As the $360.63 Caritas bill had been paid in full in April, 2008, it was not even “due and payable” when submitted to Metropolitan in June 23, 2008 . . . . Further, Chery's concern about future action by Medicare or Medicaid to seek reimbursement out of any potential tort recovery by her against the tortfeasor in no way suggested any obligation by Metropolitan to provide PIP benefits for the paid bill. “The PIP ‘benefit’ to an injured person, in substance, is the right, inter alia, to be held harmless by the insurer from claims of providers who provided treatment to the injured person.” Ny v. Metropolitan Prop. & Cas. Ins. Co., 51 Mass.App.Ct. 471, 476 (2001). Chery was in no danger of any claim against her by Caritas, whose bill had been paid in full.

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