How Are Medical Bills Paid After a Car Accident?
After you have been injured in a car accident in Pennsylvania, you might worry about how you will pay your medical bills. Even if you have medical insurance, copayments, and deductibles can quickly accumulate if you have been seriously injured and need ongoing treatment. Medical bills from unexpected accidents can be significant and can result in bankruptcy when people don’t have adequate coverage and representation. Here’s some information about how your medical bills might be paid following a Pennsylvania motor vehicle crash from the Philadelphia car accident attorneys at Raynes & Lawn.
Pennsylvania Crash Statistics
According to the Pennsylvania Department of Transportation (PennDOT), 177,899 traffic accidents happened in 2021 in the Commonwealth. These collisions resulted in injuries to 69,599 people and killed 1,230. This means that approximately 191 people were injured every day in Pennsylvania traffic collisions in 2021. While car accident injuries can range in severity, being injured in a collision might lead to rising medical bills, missed time at work, income losses, and other losses. At the same time, you might be uncertain about how you will pay your medical bills especially if your injury forces you to miss work for an extended period.
According to the National Safety Council, the total estimated cost of being injured in a car accident, including lost wages, medical expenses, production losses, and administrative expenses, was $345,000 in 2020. For people who suffered disabling injuries, the total estimated cost was $1.252 million. These estimates demonstrate exactly how overwhelming a serious car accident and its aftermath can be.
How Are Medical Bills Paid Following a Car Accident?
Injured people are initially responsible for paying their medical expenses following collisions. Many victims have insurance to pay a portion of their expenses. The type of coverage and its extent will determine how the medical bills will be paid and when. This is true even when a different motorist was responsible for causing the accident. The driver who was at fault will not have to pay for the victim’s medical bills until and unless they are found liable for the crash. This can occur through a personal injury settlement or a jury’s verdict and can take months or years to happen.
Because of how long it can take to resolve a car accident lawsuit, injured victims can face a real dilemma while their claims are pending. While they wait, their medical bills can continue to build, placing significant financial strain on them. How your medical bills might be paid will depend on your insurance coverage. An injury attorney at Raynes & Lawn can help you understand how your medical expenses might be paid based on your insurance and the specific facts of your accident.
Your Medical Benefits Coverage on Your Auto Insurance Policy
All motorists in Pennsylvania are required to have medical benefits coverage as a part of their automobile insurance. This coverage is available to motorists who are injured in car accidents. However, motorists are only required to carry medical benefits coverage of $5,000. While you can purchase additional medical benefits coverage as an option, if you don’t have additional coverage, your medical benefits coverage will likely not be enough to pay for all of the medical expenses associated with a serious injury.
You can submit a claim to your medical benefits coverage for your injuries from a car accident without having to pay a deductible. The coverage will pay your bills up to its policy limit. Once that has been reached, the responsibility for paying your medical bills will shift to you or your medical insurance.
Many motorists use their medical benefits coverage to pay for a high deductible on their health insurance plan. For example, if you accrue $60,000 in medical bills from your emergency department care and from other healthcare providers, your medical benefits coverage might only cover $5,000 of the cost. However, if your deductible on your health insurance is $7,000, the $5,000 can be used toward that and leave you with $2,000 more to pay on your deductible before your health insurance coverage kicks in.
Your Private Health Insurance or Medicaid
If you have private health insurance, Medicaid, or Medicare, your insurance company or the government will pay a portion of your medical bills. However, how much your insurance will pay will be subject to any policy limitations. You will also be responsible for meeting your deductible and paying any required copays.
The doctors who treat you should file claims with your insurance company to formally request payment for your medical expenses under the terms of your policy. If your policy doesn’t cover a specific procedure you received, the claim might be denied. In that case, you might have to pay the total cost of the procedure out of pocket. If your health insurance company refused to pay for costs that were not excluded from your policy, you should speak to your attorney to determine whether the company might have acted in bad faith.
What if You Do Not Have Health Insurance?
If you don’t have health insurance, you will have to pay your medical bills out of pocket as they accrue. You might talk to the hospital that treated you to find out about payment arrangements. Many will work with you to spread out the amount owed over a few years. If you fail to pay your medical bills, your account will likely be sent to collections.
You Were a Passenger in Someone Else’s Car
It can be confusing to figure out whether the driver of the vehicle you were a passenger in or the other motorist will be responsible for paying your medical bills. Since Pennsylvania is a no-fault state for car accidents, you can file a claim with your auto insurance medical benefits coverage. If you do not have auto insurance but are covered under your parent’s policy, you can file a claim with your parent’s insurance company. If you don’t have insurance and are not covered under anyone else’s policy, the driver of the vehicle you were in should have medical benefits auto insurance to cover you up to its policy limits. If the medical benefits coverage is not enough to cover your medical expenses and other losses, an attorney can help you file an accident claim against the at-fault driver.
If more than one auto insurance medical benefits policy might apply, only one will be the primary policy. You can’t file claims with several policies and should only file a claim with the primary policy.
Responsibility When the Other Driver Was at Fault
If you were injured in a car accident in Pennsylvania in which the other motorist was at fault, that driver’s insurance company should eventually pay for all of your medical bills up to its policy limits. However, the claims process can take months or longer before you might receive money for your medical bills.
The other motorist’s insurance company will not pay your medical bills as they accrue. You won’t be able to submit medical bills to the company to request reimbursement. Instead, your attorney will negotiate with the insurance company to try to convince it that it is in its best interests to settle your claim and pay your medical expenses. This process takes a significant amount of time and investigation before your lawyer might secure a fair settlement offer from the other driver’s insurance company.
In some cases, an insurance company might extend an early settlement offer to an accident victim. These companies are in business to make money and might try to take advantage of you when they know that you are desperate. Early settlement offers are often much less than what the victim’s claims are worth. If you accept an early offer because of your financial situation, you won’t be able to come back later to ask for more money when you learn that it wasn’t enough to cover your losses.
What if the At-Fault Motorist Is Uninsured?
If the driver who caused your accident was uninsured, you might have a couple of options. Insurance companies in Pennsylvania are required to offer uninsured motorist coverage at the time you purchase your policy. While you are not required to purchase this additional coverage, you should. Uninsured motorist coverage is relatively inexpensive and covers your losses when you are involved in an accident with an uninsured driver. This means that you could file a claim under your uninsured motorist coverage to recover compensation for your medical bills, lost wages, and other losses.
You can also file a lawsuit against the uninsured driver to try to recover compensation for your losses. As explained below, you won’t be subject to the limited tort rule even if you have limited tort auto insurance if your accident was caused by an uninsured driver. However, most uninsured drivers do not have significant assets, which means that a lawsuit against an uninsured motorist might not allow you to recover the compensation you deserve.
A related type of coverage is underinsured motorist coverage. This type of coverage will pay for your losses when they are not fully covered by the other driver’s insurance. For example, if the other motorist only has insurance that meets the state’s minimum liability requirements, the policy limits might be insufficient to pay all of your medical expenses. In that case, your underinsured motorist coverage should pay the difference between what the at-fault motorist’s insurance company pays and your total losses up to the policy limits.
If you don’t have uninsured or underinsured motorist coverage and are involved in a collision with an uninsured or underinsured driver, your attorney will carefully assess your case to try to see if there are any alternative sources of recovery through other insurance policies that might apply.
What if You Were at Fault?
If you were at fault for your accident, you can still submit a claim under your medical benefits coverage to pay for your medical bills. However, since this coverage often has low limits, it might not fully cover your expenses. If you have full coverage auto insurance, it should pay for your medical expenses and property losses up to your policy limits as well as any claims that might be filed by the other driver.
Full coverage auto insurance is more expensive than liability insurance, but it can make sense if you want more protection. If you don’t have full coverage, and your medical benefits are exhausted, you will have to pay for your remaining medical bills out of pocket or file a claim with your health insurance company.
What Does No-Fault Mean?
Several states require motorists to carry no-fault insurance that pays for some of an injured victim’s medical bills when they are involved in a car accident. This means you first file a claim with your medical benefits coverage, and it will pay for your medical bills up to the policy limits. Once that happens, the responsibility for your medical bills will shift back to you and/or your health insurance.
Pennsylvania is considered to be a no-fault state for auto accidents. No matter who is at fault for your crash, your auto insurance will cover your initial medical expenses related to treating your injuries. Your medical benefits will pay your initial expenses, but if you were seriously injured, it will likely not be enough to cover your total medical bills. Medical benefits also do not pay for other types of losses that you might have suffered.
For additional losses such as your lost earnings capacity, disability, pain and suffering, disfigurement, and others, your medical benefits will not be available. You might be able to recover additional losses beyond your medical benefits limit from the at-fault driver’s insurance company. You should consult an experienced accident lawyer to learn about your options.
Limited vs. Full Tort Auto Insurance
Under Pennsylvania law, auto insurers must offer two different types of coverage when you buy an auto insurance policy, including limited tort or full tort coverage. You need to understand the differences between these two types of auto insurance so that you can ensure you have the protection you might need if you are injured in an auto accident.
What is Limited Tort Coverage in Pennsylvania?
Under 75 Pa.C.S. § 1705, auto insurers in Pennsylvania are required to offer people two different types of insurance at the time they purchase their policies or 45 days before their policies are scheduled to renew. The first option is limited tort coverage. With this type of auto insurance, you are limited to filing an auto accident claim only for your out-of-pocket expenses, including your medical bills, wage losses, and property losses. If you have limited tort coverage, you will not be able to file a lawsuit against the at-fault driver for pain and suffering and other non-economic losses you might have suffered unless an exception applies. The exceptions that might allow you to step outside of the restrictions under a limited tort policy include the following:
- Your injury qualifies as serious under the law.
- The at-fault motorist is convicted of driving under the influence or is accepted into an Accelerated Rehabilitative Disposition program for your accident.
- The at-fault motorist caused your accident intentionally to try to harm themself or someone else.
- The at-fault motorist is uninsured.
- The at-fault driver’s vehicle is registered in a different state.
- Your accident was caused by a defective part, and your claim is against the manufacturer.
- Your accident was caused by a failure to properly repair an issue, and your claim is against the repair person.
- You were injured in an accident while riding in a vehicle that was not a private passenger car (taxi, bus, etc.).
Some people choose the limited tort option because it is cheaper and has lower premiums. However, since it can prevent you from pursuing full compensation when you are injured in a lawsuit, it is better for you to choose full tort insurance instead.
What Is Full Tort Insurance in Pennsylvania?
Full tort insurance coverage preserves your right to pursue a claim against the at-fault motorist for all of your losses, including your non-economic losses. While full tort insurance has a higher premium, it offers more protection.
Pennsylvania’s no-fault insurance rules do not apply to every accident. For example, the no-fault insurance rules do not apply to motorcycle collisions or accidents involving commercial trucks or buses.
Can my Health Insurance Company Subrogate My Case?
Under 75 Pa.C.S. § 1720, Pennsylvania has an anti-subrogation law that prohibits insurers from subrogating tort recoveries resulting from car accidents. This means that a private health insurance company generally can’t subrogate your car accident recovery award. However, there are some exceptions to this that you should understand.
First, health management organizations (HMOs) and self-insured ERISA plans are not covered by the anti-subrogation statute. This is because they fall under the Employment Retirement Income Security Act (ERISA) and are governed by federal law. Federal law allows health insurers that are covered by ERISA to subrogate personal injury claims, which means that they can place a lien on your case and recover what they paid if you receive compensation. However, if you do not win your case, you won’t have to repay the health insurance company for what it paid for your care.
Insurance companies sometimes falsely claim a subrogation right even when they are not entitled to recover money. Insurers can’t recover money out of your award unless you have been made whole and can’t seek to recover more than the fair market value of the medical services you received. If your health insurance company has filed a subrogation claim, your attorney can review it to determine whether it is a lawful claim. If there are any issues with it, your lawyer can challenge the subrogation claim.
Talk to Our Experienced Attorneys
After being injured in a car accident, you might be struggling to pay your medical bills while also dealing with lost wages while you are off from work. You should consult an experienced accident lawyer at Raynes & Lawn to understand your potential rights to recover compensation for your medical bills and other losses. Our firm has represented accident victims in Philadelphia for more than five decades, and our attorneys are dedicated to helping our clients recover full compensation for all of their losses. To learn more, contact us for a free consultation today by calling 1-800-535-1797.
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