Who pays my medical bills if I’m hurt in a car accident?

When you’re hurt in a car accident, your first priority should be receiving the medical care and treatment necessary for your injuries. Such care may initially involve an ambulance or medical helicopter, emergency room treatment, x-rays and other diagnostic tests, an overnight stay in the hospital, and possibly surgery. After your initial treatment, you may need physical or occupational therapy, follow doctor visits, additional diagnostic testing, and maybe even further surgery. Your medical condition may be such that you will need periodic, ongoing care for the rest of your life. The first question that comes to mind when facing this situation is: Who will pay my medical bills?

The logical answer, and the one most people conclude to be correct, is that the person who caused the accident, or his or her insurance company, is responsible to pay the medical bills of the injured person. After all, the person who caused the accident should be responsible for the consequences of the accident, including the bills, right?  In Pennsylvania, that’s likely not the case. Pennsylvania uses a hybrid third party/first party insurance structure for automobile insurance. Medical payments coverage is a mandatory “first party” coverage. What this essentially means is that your car insurance pays your medical bills, even if you weren’t at fault for the accident. Pennsylvania auto policies are required to be issued with no less than $5,000 in medical payments coverage. Your car insurance will be responsible to pay for at least the first $5,000 in bills, depending on the amount of coverage you purchased. If you do not have car insurance in your own name, you can seek medical payments coverage from a car insurance policy in the name of any relative of yours residing in your household, from the policy insuring the car you were occupying at the time of the incident, or from the policy insuring any car involved in the collision.

$5,000 doesn’t cover much these days with the cost of medical care. Many times, the medical payments coverage on the car insurance policy is quickly exhausted. At that point, the other driver’s insurance policy has to pay those medical bills, right? Not so, in Pennsylvania. Once medical payments coverage is exhausted under the applicable car insurance policy, the medical bills will be submitted to your health coverage, whether it is private health insurance, Medicaid, Medicare, etc. If you are uninsured, carry only catastrophic loss coverage, or have a high individual deductible/co-insurance requirement, any unpaid bill or portion of the bill will be billed directly to you. There is very rarely, in Pennsylvania, a time when the at fault driver’s insurance company will directly pay a hospital, doctor, or other medical provider for a bill incurred. Furthermore, the minimum required liability coverage in Pennsylvania is only $15,000 per person/$30,000 per occurrence. The person who caused your car accident may only have $15,000 in coverage to pay you for all of your losses and damages – medical bills, lost wages, scarring, disfigurement, pain and suffering, etc.

Pennsylvania places the burden initially on the injured victim and the only way to shift the responsibility to the at fault driver or his insurance carrier is to pursue a claim for damages. Medical bills quickly add up, especially if you do not have any insurance that can pay. Even if you have coverage, the services necessary after a car accident can quickly drain your savings, especially if the injuries prevent you from working. With the introduction of the Affordable Care Act, many secondary providers, such as doctors offices and physical therapy facilities, will not accept and treat patients without a guarantee of payment in the form of health insurance. If you are uninsured, you may have to pay up front for the full cost of each visit to receive care. If you have a co-pay requirement, you will have to pay your co-pay at the time of each visit. Even attending physical therapy 2-3 times per week for 6-8 weeks, a typical course of treatment, can cost hundreds of dollars at even a modest co-pay of $20 per visit. Unpaid medical bills can be sent to collections and reported on your credit. The hospital or provider does not care that you did not cause the accident that resulted in the medical bills.

Even if your health insurance, Medicaid, Medicare, or other group plan pays for your medical bills, that may not be the end of the medical bill story. If you pursue a claim against the at fault driver, depending on the type of health coverage you have, your claim may be required by law to include a claim for your health plan’s interests. Why should your health plan be forced to incur thousands of dollars in medical payments for your treatment when another person is legally responsible for causing the injury that required you to treat? Certain types of plans in Pennsylvania have what is called a right of subrogation against a personal injury claim – meaning if you recover for your injuries and losses, they are entitled to receive a portion of that recovery for payment of the medical bills they paid on your behalf. In order to know what type of plan you have, and whether you may have to pay something back out of your settlement toward your medical bills, it is best to speak with an experienced personal injury attorney. These types of claim are subject to both state and federal law, and can become very complex. This is especially the case if your health plan has paid significant amounts toward your medical care and treatment but the at fault driver only has $15,000 in coverage. If your health plan pays $75,000 toward medical bills, and you have missed a year of work and lost $60,000 in wages and have significant other losses, but the at fault driver only has $15,000 in coverage, who gets that money?

These questions can be daunting, especially if you are faced with the need for extensive medical care. Many people feel they are placed in a situation where they have to weight their own health and well-being against the financial concerns of incurring extensive medical bills. The best way to understand the specifics of your situation is to consult an experienced personal injury attorney. Every situation is unique and your personal circumstances require a full analysis. If you or a family has been hurt in a car accident and are dealing with mounting medical bills, contact Erin Rudert at KM&A for a free consultation regarding your case: erin@lawkm.com or 412-626-5590.