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Insurance Claim Disputes and Uninsured Motorist Claims

Massachusetts drivers carry PIP, and many carry uninsured and underinsured coverage they never knew about. We read the policy, find every layer of coverage, and challenge a denial or a lowball offer.

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Massachusetts drivers carry PIP, and many carry uninsured and underinsured coverage they never knew about. We read the policy, find every layer of coverage, and challenge a denial or a lowball offer.

We handle coverage disputes across Western Massachusetts from our offices in Springfield and Westfield. A new injury reaches a real person 24 hours a day at (413) 426-8657; the first conversation is free.

The coverage you already own

Most people know they have "car insurance" and could not say what it does. Four separate things sit inside a Massachusetts auto policy, and after a crash they behave very differently.

Personal injury protection (PIP) is no-fault. It pays your medical expenses and a share of your lost wages up to $8,000 per person, regardless of who caused the crash, and it starts paying while fault is still in dispute. If you carry health insurance, PIP and your health plan coordinate: PIP takes the first portion, your health insurer takes over, and PIP remains for what the health plan will not cover and for wage loss.

Bodily injury liability is the part that pays other people when you are at fault. It does nothing for you.

Uninsured motorist coverage stands in for a driver who had no insurance at all, and for a hit-and-run driver who is never identified.

Underinsured motorist coverage fills the gap when the at-fault driver had a policy but not one big enough for what they did. Massachusetts minimum limits are low, and a serious injury runs through them quickly, which makes this the coverage that quietly matters most.

The last two are the ones people are surprised to learn they have. They are also claims against your own insurer, which changes the relationship in ways worth understanding.

Why a claim against your own carrier turns adversarial

When you claim on your own uninsured or underinsured coverage, your insurer is no longer the company that sold you a policy. On that claim it is the party that pays if you are right, and it evaluates you the way it would evaluate a stranger suing its insured.

People find this genuinely disorienting - they have paid premiums for fifteen years and expect goodwill. What they get is a claims process. That is not necessarily bad faith; it is the structure. But it does mean the friendly assumption most people bring to the first phone call is misplaced, and that a recorded statement given in that spirit can be used later.

The threshold, and why an adjuster mentions it

For injuries from a motor vehicle crash, Massachusetts limits who can claim pain and suffering. You clear the threshold if your reasonable medical expenses reach $2,000 - or, regardless of what the bills total, if the injury involved a fractured bone, substantial disfigurement, permanent and serious loss of hearing or sight, or death.

This gets raised early by adjusters as a reason your claim is worth nothing. Often the honest answer is that the threshold has not been reached yet, because you are still treating. It is a checkpoint, not a verdict.

When a denial is more than a denial

Massachusetts is unusual, and favorable, here. Insurers operating in the Commonwealth are subject to a list of prohibited unfair claim settlement practices - among them refusing to pay without a reasonable investigation, failing to respond to communications promptly, and failing to make a prompt, fair, and equitable settlement once liability has become reasonably clear.

Violating that list is treated as a violation of the consumer protection statute, which means an insurer that handles a claim unreasonably is exposed to more than the amount it should have paid: the statute provides for multiple damages and attorney's fees. The process begins with a written demand letter that gives the insurer a defined window to respond.

That is a real lever, and it is one of the reasons a claim that stalled for months can move quickly once counsel is involved. It is not automatic - a genuine, reasonably investigated dispute about a claim is not bad faith - but a denial that cannot be explained is a different matter from a denial you disagree with.

What to do now

Get us the full policy, not the ID card - the declarations page and the policy booklet, for every vehicle in the household. Keep every letter and email from the insurer, and note the date of every call and who you spoke to; a bad-faith claim is built out of that record and cannot be reconstructed later.

Do not give a recorded statement before you understand what coverage you are claiming under. And bring us the offer before you accept it. The first conversation is free, and if the offer on your table is already a fair one, we will tell you that.

Common questions

Insurance Claim Disputes FAQs

My own insurer denied my claim. Can they do that?

They can deny it, and they are sometimes right. What they cannot do is deny it unreasonably. Massachusetts treats unfair claim settlement practices as a violation of the consumer protection statute, and one of the listed practices is failing to make a prompt, fair, and equitable settlement when liability has become reasonably clear. That is a claim in its own right, separate from the underlying accident, and the remedies include multiple damages and attorney's fees.

What is PIP and how much is it?

Personal injury protection is the no-fault medical and wage coverage on every Massachusetts auto policy. It pays regardless of who caused the crash, up to a limit of $8,000 per person. If you have health insurance, PIP covers the first portion of your medical bills, your health insurer takes over, and PIP remains available for what your health plan does not cover and for lost wages - it pays a percentage of what you actually lost, not all of it.

Why do I need $2,000 in medical bills before I can sue?

Because Massachusetts is a no-fault state and limits pain-and-suffering claims arising from motor vehicle crashes to cases that clear a threshold. Reaching $2,000 in reasonable medical expenses is one way over it. So is a fractured bone, substantial disfigurement, permanent and serious loss of hearing or sight, or death - any one of those clears the threshold no matter what the bills total.

The other driver had no insurance. What now?

You claim against your own uninsured motorist coverage, which is on your policy for exactly this. It also covers a hit-and-run driver who is never identified. Underinsured motorist coverage does the parallel job when the driver had insurance but not enough. This is the coverage people most often forget they bought, and the claim is against your own carrier - which is precisely why these claims turn adversarial and often need representation.

They offered me money. How do I know if it is fair?

You mostly cannot, from the inside, which is what the first offer is built on. It arrives before the treatment is finished, before anyone knows whether the injury is permanent, and while the bills are frightening. A reasonable offer is one made after the medical picture is settled, against known bills, known wage loss, and a documented account of what the injury actually cost you. If an offer arrives before those are known, it is priced on the insurer's hope, not on your file.

Is there a deadline?

Yes, and more than one. A claim against the at-fault driver generally runs three years from the crash. A claim on your own policy is a contract claim and can carry its own deadlines and notice conditions written into the policy itself - some of which are much shorter and can be missed while you are still treating. Bring us the policy early enough that those conditions are still open.

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Springfield, Main Office

185 Belmont Avenue, Springfield, MA 01108

Westfield, Personal Injury Law Center

56 Washington Street, Westfield, MA 01085

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