Who Pays for Medical Expenses After a Car Accident?

You Are Responsible for Your Ongoing Medical Expenses

Even if you are not at fault for a car accident, you must still pay for your ongoing medical expenses. The at-fault driver is ultimately responsible to pay for your medical expenses. But the at-fault driver’s insurance company won’t pay your doctors directly or reimburse you for your medical bills as you incur them. They will reimburse you for your medical expenses only when you reach a settlement with them or, if you aren’t able to negotiate a settlement, when their liability for the medical expenses is established by a court or arbitrator. And while a settlement with the other driver’s insurance company will include payment for your medical expenses, that insurance company will demand that you release their insured from any claims as a condition of making the settlement payment. This is why it is not a good idea to settle your claim with the other driver’s insurance company’s insurance company until you are done treating, or at least have a good idea how much your future treatment will probably cost. But sometimes car accident victims will continue treating for months or years before their injuries resolve or stabilize.

PIP Coverage

In Washington, auto insurance policies are required to offer personal injury protection coverage with a minimum limit for medical and hospital benefits of $10,000, unless the insured rejects this coverage in writing. RCW 48.22.085 & RCW 48.22.095  The purpose of PIP coverage is to pay for your ongoing medical expenses as you incur them. PIP coverage will pay your ongoing medical expenses even if you are at fault for a car accident. But you will be obligated to reimburse your auto insurance company for medical expenses paid by your PIP coverage if you do ultimately recover the medical expenses PIP paid from the at-fault driver. In Washington, however, you may not have to reimburse your PIP insurer if your recovery from the at-fault driver does not make you whole. And if you are obligated to reimburse your auto insurer for the medical expenses it pays under your PIP coverage, the insurance company is obligated to reduce the amount of that reimbursement by an amount that reflects its share of the attorney fee and litigation costs you incurred to obtain that reimbursement for it. For example, if you are paying a one-third contingent fee to your attorney, your insurance company is obligated to reduce the amount of its PIP reimbursement by one-third (plus its pro rata share of any litigation costs you incurred).

Health Insurance

Your own health insurance should also pay for your ongoing medical expenses. However, if you do have PIP coverage, you should first use it to pay for your medical expenses. PIP coverage has no deductibles and your health insurer may require you to exhaust your PIP benefits before they will pay for your ongoing treatment. But if you do not have PIP insurance, or you have exhausted the limits of your PIP coverage, use health insurance if you have it. Your health insurance will keep track of your treatment they believe is related to the auto accident and require reimbursement of those payments if you make a recovery from the at-fault party. In Washington, the health insurer may be required to reduce its reimbursement by its pro rata share of the attorney fee and costs you incurred to obtain that funds to reimburse it. However, many health insurance plans are governed by the Employee Retirement Income Security Act (ERISA). Federal law will govern the extent to which health insurance plans governed by ERISA must be reimbursed when an insured makes a recovery from an at-fault party.

Medicaid and Medicare

If you are on Medicaid or Medicare prior to a car accident, they will pay for your ongoing treatment for injuries received in the accident in much the same way as health insurance will. Again however, there are special rules that must be followed in reimbursing Medicaid and Medicare for accident related expenses when you make a recovery from an at-fault party.

Medical Lien

If you do not have any insurance to pay for your ongoing medical expenses, some medical providers may be willing to defer payment if you agree to pay them back out of your recovery from the at-fault party. It is important that you confirm with a medical provider they are willing to do this. Your medical provider is not required to give you an attorney fee reduction when you pay the them back and you may have to pay interest on the outstanding balance. Your lawyer may be able to negotiate a reduction, however.

Out-Of-Pocket

The last option to get medical bills paid on an ongoing basis is to pay them out of pocket. If you have to resort to this option, you should still be reimbursed out of the recovery from the at-fault party. So you or your lawyer should keep careful track of the expenses you pay out-of-pocket to make sure you are reimbursed in full.