When another driver is at fault for an accident you can take comfort in knowing they are responsible for your medical expenses, but the insurance companies can take days or weeks to determine who was at fault for an accident, so how do your medical bills get paid? Do you need to show your health insurance or your auto insurance at the hospital? Do you need an attorney to help you get the money you are owed?
Car insurance can seem needlessly complex, but knowing who to contact about your claim and how your medical bills are paid after a car accident can help make the process less confusing and ensure you get all the benefits you are entitled to according to the applicable policies.
After an accident, the at-fault driver’s auto insurance will pay for injuries, but it can take some time for an insurance company to process the information and send out a payment
Car insurance companies don’t usually pay medical bills directly, so health insurance pays first and is reimbursed by auto insurance later
How to claim medical expenses after a car accident depends on whether you are in an at-fault state or a no-fault state
How are medical bills paid after a car accident?
While the at-fault driver’s auto insurance will pay for damage up to the limit of their liability coverage (a limit is just the maximum amount their insurance will pay out), it can take some time for an insurance company to process the information and send out a payment. This is especially true in situations where someone has been injured, because they can’t know how much to pay for your injuries until you have been treated by a doctor.
There are several ways your medical bills could be paid after an accident, depending on the situation and the laws in your state.
By your health insurance
In almost every instance, your health insurance will be billed first. Whether your health insurance comes from your employer, the marketplace, Medicare, or Medicaid, your health insurance company will be billed for any car accident medical bills you may have and will later expect to be reimbursed from any settlement or payout you receive from the at-fault driver’s car insurance company.
This means you will be responsible for paying any deductible or copays that may be required by your health insurance. Make sure to keep receipts of everything you pay toward accident-related medical expenses, including prescriptions and dental expenses, along with the explanation of benefits your health insurance company provides so you know exactly how much the at-fault driver is responsible for after the dust has settled.
Out of pocket
If you don’t have health insurance, you can expect to pay for medical costs out-of-pocket. If the other driver is at fault you will be reimbursed by their car insurance company for any expenses related to the accident (up to the policy limits) so keep track of all of your medical bills and anything you paid out-of-pocket so you know exactly how much the insurance company should pay.
By your PIP or MedPay coverage.
Drivers who live in a no-fault state are required to have personal injury protection (PIP) coverage, which is a type of insurance designed to pay your medical bills in the event of an accident, no matter who is at fault. Drivers in at-fault states sometimes have access to PIP or other types of insurance like medical payments (MedPay) coverage, which is a type of car insurance coverage designed to pay a small amount toward your medical expenses after an accident, typically less than $10,000.
This type of coverage will reimburse you for your medical expenses up to the limits of your policy. Once you have expended those limits, you can then reach out to the at-fault driver’s insurance company for any liability coverage the driver may have.
If they don’t have any liability coverage or they only have a small amount of liability insurance, you can file a claim through your uninsured motorist (UM) coverage if you have it on your policy. If all of those options have been exhausted and there are still medical bills left unpaid, you may need to find an attorney who can help you file a suit for any money owed.
Who pays first—health insurance or auto insurance?
Car insurance companies usually don’t pay medical bills directly, which means that, in almost every instance, health insurance pays first. You may be able to provide the auto insurance information to your health insurance company so they can coordinate benefits, which is the simplest solution.
If your insurance company doesn’t allow you to process things this way, you can save receipts and any explanation of benefits you may receive so you can submit them to your car insurance company for reimbursement.
Repaying Medical Expenses
Remember, the auto insurance company is responsible for paying your medical bills up to the limits of the policy. This means that if your health insurance company pays $10,000 for medical expenses after an accident, they expect to be repaid that $10,000 out of any payment or settlement you receive. Don’t make an extravagant purchase or pay off unrelated bills with a check from your auto insurance company until you are certain your health insurance has been fully reimbursed for their expenses.
How does car insurance work when you are not at fault?
How to claim medical expenses after a car accident depends on whether you are in an at-fault state or a no-fault state.
In an at-fault state, the at-fault driver’s bodily injury liability insurance will cover your medical expenses by reimbursing you or your health insurance for any incurred costs. If they don’t have enough coverage to pay for all of your bills (or worse, they don’t have car insurance at all) you may need to use your own benefits, such as MedPay or uninsured motorist coverage, to help cover additional medical expenses.
If you live in a no-fault state, you’ll need to file medical claims directly with your PIP coverage. You can reach out to your insurance agent and they can help guide you through the process of filing a PIP claim. Once you have met the limits of your PIP coverage, the other driver’s liability coverage would step in to pay additional expenses, up to the limits of their policy.
If I hire an attorney will I get a legal settlement?
In some instances, drivers may need to hire an attorney when claiming medical expenses after a car accident. If you are facing significant medical bills or the insurance company responsible for your expenses is not acting in good faith, hiring legal assistance might be worth it for you.
However, just because you hire a lawyer doesn’t guarantee you will win your case or be awarded enough money to cover your expenses. If you decide you need legal help, make sure to do your research so you know you are choosing the right lawyer for you.
Frequently Asked Questions
Do you have to pay your medical bills from a personal injury settlement?
Yes, you will be expected to reimburse your health insurance company for anything they paid toward your medical bills after your accident, as well as paying for any expenses that were not covered by your health insurance. It is possible you might be awarded more than the cost of your medical expenses in a legal settlement, but it isn’t guaranteed, so don’t expect to walk away from a car accident lawsuit with “free money” that isn’t earmarked for medical bills.
Is pain and suffering separate from medical bills?
Yes, pain and suffering is separate from medical bills. Pain and suffering typically isn’t included in liability coverage, though some expenses (lost wages, childcare, etc.) can be included in a PIP claim. If you believe you should be compensated for pain and suffering, you will need to reach out to an attorney for assistance.
Why do insurance companies pay less for medical bills?
Because of their size and financial influence, insurance companies have a significant amount of negotiating power when it comes to how much they will pay for medical bills. Individuals don’t have this kind of power, so they are often charged significantly more than insurance companies for the same products and services.
Does disability insurance pay out after a car accident?
If you are injured to the point where you miss work, your disability insurance will pay out after the accident. If you have both short term and long term disability insurance, your short term coverage will kick in (after a brief waiting period) and then, if necessary, your long term insurance will pick up after your short term coverage ends. Waiting periods and benefit periods will be specific to your plan, so reach out to your insurance company for more information about what to expect with your policy.