Appellate Court Reverses Summary Judgment for Insurer in Case Involving Alcohol Exclusion in PIP Benefits Insurance Policy

Legal News GavelOne of the most complex aspects of a car accident claim is working with insurance companies and ensuring that you are treated fairly. Having an experienced and tenacious Boston car accident lawyer on your side can help ensure that you receive the outcome that you deserve. In a recent appellate decision, the court considered the application of an exclusion in an insurance policy. In the case, the driver suffered serious injuries in a car accident that occurred in an intersection. She was taken to the hospital where she received treatment for her injuries. The records indicated that the driver’s breath had an odor of alcohol and that she was intoxicated at the hospital. The police report that was prepared for the accident did not state anything regarding intoxication, however. It also lacked an explanation of how the accident occurred or where the vehicles were traveling before colliding.

The medical provider who treated the driver sought reimbursement from the driver’s auto insurance company. The insurer paid the first claim for reimbursement, but refused to pay any remaining amounts on the basis that the insurance policy contained an alcohol exclusion. The medical provider filed a lawsuit and the insurer moved for summary judgment based on an affidavit from its employee and hospital records. The plaintiff opposed the motion on the basis that there was a genuine issue of fact in the case regarding whether the driver was driving under the influence at the time of the crash and whether this contributed to her injuries. The lower court granted the defendant’s motion for summary judgment and an appellate division affirmed. The plaintiff appealed.

On review, the appellate court first noted that PIP benefits are required for all motor vehicle insurance policies in Massachusetts. These benefits are designed to cover all reasonable expenses that the insured incurs within two years from the date of the accident for any necessary medical services. The insurer must pay them regardless of fault. Statutes in the state also allow insurers to avoid paying PIP benefits if the insured contributed to his or her own injuries, including while under the influence of alcohol. Based on this, to prevail on summary judgment the insurer needed to show that the driver’s conduct contributed to her injuries.

Reviewing the record, the appellate court noted that there was no evidence regarding how the accident happened or whether the driver contributed to it. Also, the record lacked any affidavits or deposition testimony from individuals who either were involved in or who witnessed the accident. Based on the foregoing information, the appellate court reversed summary judgment in favor of the defendant and remanded the case for further proceedings.

If you were injured in a crash and are involved with an insurance company dispute, we are standing by and ready to assist you. Policy terms can be incredibly confusing and it can be hard to know if you are receiving the fair treatment that you deserve. Our seasoned team of car accident lawyers has guided numerous Boston residents through the claims and litigation process. To schedule your free consultation, call us now at 617-263-0060 or contact us online.

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