Massachusetts PIP coverage pays up to $8,000 for medical bills and lost wages after a car crash. When the bills add up to more than that, someone does not get paid. A recent decision from the District Court’s Appellate Division says the insurer, not the calendar, decides who that is.
In Brewster Ambulance Service, Inc. v. Arbella Insurance Group, App. Div. No. 25-ADCV-36SO (July 3, 2026), the Southern District of the Appellate Division held that an auto insurer is not required to pay medical bills “either in the order in which the provider rendered services or in the order in which the bills were received.” The ambulance company that billed first was left unpaid, and the court affirmed judgment for the insurer.
The full opinion was not available to us. This account is based on the excerpts published by Massachusetts Lawyers Weekly on October 15, 2026, and on the PIP statutes, G.L. c. 90, §§ 34A and 34M, which we read at malegislature.gov.
What happened
According to the excerpts:
- Brewster Ambulance, Boston Medical Center and Teamwork Physical Therapy all treated the same Arbella policyholder and billed for it.
- By the time Arbella received the policyholder’s PIP application and finished its investigation, the three providers’ bills “well exceeded the $8,000.00 in PIP coverage available under Arbella’s policy.”
- Arbella applied all $8,000 to Boston Medical Center’s bill. Brewster, which had submitted its bill first, got nothing.
- Brewster sued in Quincy District Court. The judge granted summary judgment to Arbella, and Brewster appealed.
As the court framed it: “the order in which Arbella decided to pay the bills ultimately determined which provider was paid (i.e., BMC) and which were not (e.g., Brewster).”
Brewster’s argument: “due and payable as loss accrues”
Brewster relied on one sentence of § 34M. As we read it on malegislature.gov, it says PIP benefits “shall be due and payable as loss accrues, upon receipt of reasonable proof of the fact and amount of expenses and loss incurred provided that upon notification of disability from a licensed physician, the insurer shall commence medical payments within ten days or give written notice of its intent not to make such payments, specifying reasons for said nonpayment, but an insurer may agree to a lump sum discharging all future liability for such benefits on its own behalf and on behalf of the insured.”
Brewster read “due and payable as loss accrues” to mean first in, first paid: the insurer should pay bills in the order it receives them.
What the court held
The Appellate Division rejected that reading for two reasons, according to the excerpts.
1. The clock starts with the PIP application, not the bill. Read “with reference to the whole statute,” the court said, the phrase “simply mean[s] that an insurer’s obligation to pay PIP benefits … is triggered only when the claimant presents a valid PIP claim, which is achieved by submitting a completed PIP application.” Only then does the ten-day requirement apply. So Brewster’s earlier bill did not create an earlier obligation to pay it.
2. The “lump sum” clause gives the insurer discretion. Although Arbella had not made the argument, the court pointed to the end of the same sentence, which allows an insurer to “agree to a lump sum discharging all future liability.” The court said it could “discern no other reason for the inclusion of this language but for the purpose of affording the insurer discretion as to which bill(s) to pay in an excess situation such as presented here.”
The court added that its reading fits the no-fault statute’s general purpose, which it described as streamlining claims, reducing litigation costs and promoting the expedient processing and payment of medical bills.
What this means if you were hurt in a crash
- The $8,000 limit. Under § 34A, PIP pays reasonable medical expenses and certain lost wages “to the amount or limit of at least eight thousand dollars on account of injury to or death of any one person.” The statute makes $8,000 the minimum.
- Health insurance changes the math. If you have health insurance, § 34A provides that PIP will not pay “more than two thousand dollars” of medical expenses to the extent those expenses are paid by your health plan. In practice, that generally means PIP pays the first $2,000 of medical bills and your health plan pays covered bills after that. The exhaustion problem in Brewster is sharpest for people without health insurance or with large uncovered bills.
- File the PIP application promptly. The decision ties the insurer’s payment obligation to a completed PIP application. Bills sent before then do not start the ten-day clock.
- What happens to the unpaid bill. The excerpts do not address what happens next to a bill PIP did not pay, such as whether it goes to health insurance or becomes part of a claim against an at-fault driver.
What it means for providers
Being first to bill is no guarantee of payment when the bills exceed the limit. Under § 34M, when benefits “due and payable remain unpaid for more than thirty days,” an unpaid party “shall be deemed a party to a contract with the insurer” and may sue for payment. But Brewster holds that once the coverage is properly exhausted, there is nothing left that is due.
How much weight the decision carries
The Appellate Division hears appeals in civil cases from the District Court. Its decisions are not rulings of the Appeals Court or the Supreme Judicial Court, and we found no report of a further appeal. The excerpts do not say whether insurers must act in good faith in choosing among bills, or whether a choice made for an improper reason could be challenged.
Frequently asked questions
What happens when PIP benefits run out in Massachusetts?
Once the $8,000 in PIP coverage is used up, the insurer has no further PIP obligation. What happens to the remaining bills depends on other coverage, such as health insurance, and on whether another driver was at fault.
Does a PIP insurer have to pay medical bills in the order they are received?
No, according to the Appellate Division in Brewster Ambulance Service, Inc. v. Arbella Insurance Group (2026). The court held the insurer is not required to pay bills in the order services were provided or bills were received, and has discretion over which bills to pay when they exceed the limit.
How long does a PIP insurer have to pay?
Under G.L. c. 90, section 34M, after notification of disability from a licensed physician, the insurer must start medical payments within ten days or give written notice of its reasons for not paying. The Appellate Division held this obligation is triggered by a completed PIP application.
Why did my PIP only pay $2,000 of my medical bills?
If you have health insurance, G.L. c. 90, section 34A limits PIP to $2,000 of medical expenses to the extent your health plan pays them. Your health insurer covers eligible bills after that.
Sources: Brewster Ambulance Service, Inc. v. Arbella Insurance Group, App. Div. No. 25-ADCV-36SO (Mass. Dist. Ct. App. Div., Southern Dist., July 3, 2026), as excerpted by Massachusetts Lawyers Weekly, October 15, 2026 (Lawyers Weekly No. 13-037-26). We did not have access to the full opinion. G.L. c. 90, sections 34A and 34M, read at malegislature.gov. General information about Massachusetts law, not legal advice.