Who Pays My Medical Bills If I Am Involved In An Accident?

When a client is involved in an accident resulting in personal injury, we are often asked who pays for the client’s medical bills.  The answer is not simple and depends on what part of the process you are in.  In short:

• Your auto insurance company pays first under “PIP/no-fault” coverage (and MedPay)

• Then you or your health insurance pay the bills

• Then the at-fault driver’s auto insurance company may pay for some bills

• Then your auto insurance company may pay (again) under “UM” or “UIM” coverage

Your auto insurance company pays first under “PIP” or “no-fault” coverage

The first one to pay for your medical bills is your own auto insurance company under the Personal Injury Protection (PIP) coverage in your policy.  Florida is a “no-fault insurance” state, which means that after an accident, your own insurance coverage pays a percentage of your medical bills and other financial losses up to $10,000, regardless of who was at fault for the accident. 

To take advantage of your PIP coverage, it is important to contact your insurance company and make a claim even if you are not at fault for the accident.  Failure to make a timely claim can reduce the benefits amounts available.  

Note also that if you have medical payments (“MedPay”) coverage on your policy, your insurance company will pay for your medical bills after PIP coverage has been exhausted, up to the coverage limit.

You or your health insurance pays second

Once your PIP and MedPay benefits have exhausted, you should use your health insurance to pay for your medical expenses.  Doing so allows you to take advantage of negotiated group rates which will pay the charges at pre-approved group insurance plan rates.  Any co-pays or co-insurance are your responsibility to pay.

If you do not have health insurance, you are responsible for all of your medical bills after your PIP coverage has been exhausted.  Even though your accident and related injuries may have been caused by someone else, the treatment and services for the injuries were received by you. These bills are 100% your responsibility; although the person who caused the accident may ultimately be responsible for paying for these expenses at a later date. 

You can also work with your car accident attorney to find potential alternative options to partially cover medical bills until your case is resolved.

For example, some medical providers will agree to treat you without immediate payment, in exchange for an agreement from you to pay them out of any settlement you reach with the at-fault driver’s insurance company (which gives the provider a “lien” on your settlement).  This kind agreement is called a “letter of protection.”  However, not all medical providers are willing to treat you with a letter of protection.  Providers who perform your medical treatment are under no obligation to wait to be paid for their services. 

The at-fault driver’s insurance company may pay for your medical bills

If the at-fault driver has bodily injury coverage through his or her auto insurance company, that insurance company may pay for your medical bills that were not covered by PIP.  However, this only happens after you have recovered money from that insurance company in a settlement or a judgment (“judgments” are what you get after a trial). The at-fault driver’s insurance company does not pay your medical providers directly; instead, it pays you as part of a settlement or after a judgment.  

Then you use that money either to reimburse yourself for medical bills you have paid in the past, to pay outstanding medical bills with your providers, or to reimburse your insurance companies for bills they have paid on your behalf.  

Obtaining a settlement with, or judgment against, the at-fault driver’s insurance company can take months or, in some cases, years.  This is why it’s important to submit your medicals bills to your health insurance company along the way, so you can ensure that the providers are getting paid and you can continue your treatment. 

Your auto insurance company may pay (again) under your “UM” or “UIM” coverage

If you have uninsured motorist (UM) or underinsured motorist (UIM) coverage, then your auto insurance company may pay some of your medical bills as well.  

UM or UIM coverage comes into play when the at-fault driver either has no bodily injury insurance or not enough bodily injury coverage to pay for your injuries and expenses.  In that circumstance, you can make a claim with your auto insurance company for UM or UIM benefits.  

Any settlement with, or judgment obtained against, your auto insurance company may include payment for medical bills that were not paid by PIP coverage or the at-fault driver’s insurance company.

Personal injury and medical costs resulting from an accident are never easy to deal with. You should always take care of your health first. Any medical bills should be submitted timely to your insurance companies. Reach out to Slater | Grant with any concerns and questions about medical bills following an accident. We are ready to help any way we can.