In my practice as a personal injury lawyer, I am often explaining to my clients the interplay between the various insurance coverages that may provide coverage to them for medical expenses following an injury accident.
More often than not, if you are injured in an accident, you may have more than one policy of insurance available to pay medical expenses. Let me briefly explain these coverages to you.
First and foremost, there is health insurance including private PPO coverage, private HMO coverage, Medicare and Medi-Cal. Some people are confused when they are in an accident, believing that they should not use their health insurance to pay ambulance, hospital and doctors’ bills. This is simply not true. Use your health insurance first, and be certain to provide your health insurance information to all of your medical providers. If you are too injured to do so, ask a loved one to do it for you. Your medical providers can then submit your medical bills to your health insurer and you can avoid collections.
Now, if you were injured while on the job, the situation is different. For on-the-job injuries, you need to immediately report the injury to your employer and then submit your claim to workers’ compensation. The workers’ compensation system is available to pay your medical bills.
In addition to health insurance, if you have been injured in a motor vehicle collision, you may have “Med-Pay” coverage on your automobile insurance. Med-Pay is usually written in smaller limits, generally $5,000 to $10,000. I advise my clients who have health insurance to first submit their medical bills to their health insurer, and then use the Med-Pay coverage for things like deductibles and co-pays. If you do not have health insurance, but you do have Med-Pay, you can use the Med-Pay coverage up to your policy limits to pay medical expenses you have incurred.
In an auto collision case, the other driver may be responsible for your medical bills, too. However, they will likely not pay the bills in a piece-meal, or periodic fashion. Typically, your claim against the other driver will settle only once, meaning you will only get just one check from the other driver’s insurer for your injury claim. This usually means you need to wait until your medical treatment is complete before settling, and this may be several months or more after the collision. In the meantime, use your health insurance and Med-Pay to pay outstanding bills and avoid collections.
If you use your health insurance or Med-Pay to pay medical expenses, and then you later settle your case with the other driver, your health insurer and Med-Pay insurer may assert a “lien” against your settlement. A lien is typically asserted because the other driver is paying you for medical expenses that were already paid by someone else (like your health insurer). For you to collect a reimbursement of medical expense from the other driver, for medical bills you did not pay, you would effectively be getting a double recovery. The law allows your insurer (the entity that paid the bills) the ability to get their money back. Liens in this context can be quite complicated.
This is all a very simplified explanation of the various health insurance coverages that may be available to following an injury accident. Talk with an attorney for more information and advice.
Matthew Clark is a senior partner at Chain | Cohn | Stiles where he focuses on wrongful death, motor vehicle accident, and other personal injury cases for people of Kern County.