In Massachusetts, Personal Injury Protection (PIP) insurance is supposed to offer quick access to medical coverage after an auto accident. But what happens when those benefits are “exhausted” and your practice is still waiting to be paid?
That’s where Exhausted Benefit Recovery becomes critical. Many insurers claim that PIP coverage is used up to deny ongoing payments—even when providers haven’t been fully reimbursed or when benefits were misapplied. At The Massachusetts Personal Injury Protection Lawyers, we specialize in helping hospitals, imaging centers, and clinics pursue payment when insurance companies refuse to pay due to “exhausted” PIP limits.
This service ensures providers recover what they’re owed—even after PIP benefits supposedly run out.
PIP benefits in Massachusetts typically cap at $8,000 per person, covering medical bills, lost wages, and replacement services. But insurers often claim this limit has been met long before it actually has. In many cases, benefit exhaustion is cited prematurely, inaccurately, or as a tactic to shut down further payments.
True exhaustion occurs when all $8,000 has been properly applied toward eligible costs. However, insurers may:
Apply deductions not allowed under the statute
Prioritize wage loss over medical payments
Use IME denials to stop payment early
Withhold payment without proper calculation
When this happens, providers are left with unpaid balances and nowhere to turn—unless they pursue Exhausted Benefit Recovery through legal channels.
Medical providers rely on PIP reimbursement to remain financially stable after treating auto accident victims. When those payments are halted due to false exhaustion claims, your practice may be forced to write off significant revenue.
Any healthcare provider billing auto insurers under Massachusetts PIP law may encounter benefit exhaustion roadblocks. From major hospitals to smaller clinics, our legal team helps providers across the spectrum fight back when insurers claim there are no funds left.
MRI and diagnostic centers
Physical therapy clinics
Orthopedic practices
Community health centers
Chiropractors
Hospitals and urgent care clinics
Pain management providers
Whether you handle 5 claims or 500 per month, we can help you assess and challenge exhausted PIP denials.
Insurance carriers may misrepresent exhaustion in several ways. Knowing the red flags can help you identify when legal support is necessary.
Insurer says benefits are exhausted but you never received payment
Multiple bills are pending with no recent communication
Benefits were applied toward services you didn’t provide (e.g., lost wages)
IME denials are used to cut off payments without exhausting the cap
Partial payments suddenly stop without explanation
If any of the above apply to your claims, it’s time to consider Exhausted Benefit Recovery with legal representation.
At The Massachusetts Personal Injury Protection Lawyers, we dig deeper than surface-level denials. Our attorneys review the full benefit ledger, payment breakdowns, and insurer correspondence to determine whether benefits were truly exhausted—or simply misused.
We act quickly to:
Audit the PIP payment ledger for errors
Recalculate the balance owed under Massachusetts law
File legal demands challenging exhaustion status
Pursue payment from secondary or supplemental sources
Litigate wrongful denial cases in court
With our no-recovery, no-fee model, there’s zero risk to your practice. You only pay if we recover.
Massachusetts General Law Chapter 90 §34M outlines how PIP benefits must be applied. It does not allow insurers to cut off payments arbitrarily or prioritize other expenses without proper justification.
Under the law:
Providers are entitled to prompt payment unless benefits are truly exhausted
Exhaustion must be supported by documentation and a full accounting
Insurers must provide an explanation for the status of benefits upon request
Misapplication of benefits can be challenged through legal action
By enforcing your rights under this statute, we help providers avoid financial losses and get paid faster.
If PIP coverage is genuinely exhausted, there are still legal options available. Exhausted Benefit Recovery doesn’t stop at checking the $8,000 cap—it looks for every possible route to reimbursement.
Optional Bodily Injury Coverage
In some cases, the injured party may have coverage that supplements PIP limits.
Medical Payments (MedPay)
A separate part of auto policies that can be used for outstanding bills.
Third-Party Liability Claims
We coordinate with personal injury lawyers to include unpaid bills in future settlements.
Health Insurance Coordination
When PIP is exhausted, remaining charges may be directed to the patient’s health insurer.
Our attorneys provide the experience and legal backing to challenge improper exhaustion and ensure full compliance with the law.
Claim Review
We analyze unpaid bills and insurer responses for exhaustion indicators.
Benefit Ledger Audit
Our team reviews how the $8,000 limit was applied and identifies misuse.
Demand & Legal Filing
If errors are found, we issue a legal demand or file suit to correct them.
Pursue Supplemental Options
If benefits are truly exhausted, we identify other ways to recover unpaid balances.
Recovery & Disbursement
Once resolved, payment is issued and your practice receives the funds owed.
This process is efficient, transparent, and always aligned with your best interest.
Our firm focuses exclusively on PIP-related issues, including Exhausted Benefit Recovery, across Massachusetts. With years of experience and a deep understanding of insurer tactics, we fight aggressively to ensure medical providers are fully compensated for the care they provide.
99% success rate in challenging PIP denials
Contingency-based legal services—no fee unless we recover
Fast response time and complete claim tracking
Representation across Massachusetts, from Boston to Springfield
Trusted by MRI centers, PT clinics, hospitals, and more
You’ve done the work. You’ve provided the care. Now let us fight to get you paid—whether benefits were truly exhausted or just misapplied. At The Massachusetts Personal Injury Protection Lawyers, we stand up to insurers and make sure your practice is protected from revenue loss.
Reach out for a free consultation, and we’ll review your claims, audit benefit use, and recommend a recovery strategy tailored to your needs.
Contact our legal team today for a free case evaluation and start recovering your unpaid PIP claims. No upfront fees — just results.
We handle the legal heavy lifting so your team doesn’t have to. From identifying violations of PIP law to aggressively pursuing litigation when needed, we tailor our strategy to fit your goals. And because we operate on a no recovery, no fee basis, there’s no financial risk to your practice.
At The Massachusetts Personal Injury Protection Lawyers, LLC, we focus solely on helping medical providers recover what they’re owed — quickly and effectively. Our firm covers all filing costs upfront and never charges a fee unless we win your case. With personalized legal strategies and statewide service, we make PIP collections simple and stress-free.
We exclusively serve hospitals, clinics, and healthcare professionals across Massachusetts, giving us unmatched insight into PIP law and provider rights.
From claim review to litigation and appeals, we handle everything — so your staff doesn’t have to deal with paperwork, insurers, or court filings.
Our services are contingency-based — you pay nothing unless we recover funds for you. No upfront costs, no hidden fees, just results.
