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Does My Health Insurance Cover Car Accident Injuries?

health insurance car accident injuries


If you’ve been injured in a car accident you’re probably wondering how to get your medical bills covered. If more than one insurance policy is in play it can be confusing to sort it out.

We’re here to help you dig into the details, understand your payment options, and ensure that you are covered.

In the following, we’ll cover….

Who Pays For My Medical Bills After an Accident?
When Does My Health Insurance Pick up the Costs?
How Does Fault Factor Into Paying My Medical Bills?

Let’s get started….

Who Pays for My Medical Bills After an Accident?

The payment of your medical bills follows a basic process:

Paying a Deductible

Regardless of whether you are talking about an auto policy or health insurance plan, you’ll need to pay the bills yourself up to your insurance policy deductible limit.

The amount of this self-insurance varies policy to policy.

You obviously won’t be expected to pay for doctor's visits or medical tests upfront. Rather, the medical provider will work with you and your insurance company to make sure the deductible is fulfilled before continuing to bill the insurance company.

Payment From Your Auto Insurance Policy

Past the deductible, auto insurance policies are generally considered “primary” insurance for accident related injuries. This means that the auto policy pays first.

Most states require drivers to carry personal injury protection coverage or “PIP”.

PIP is designed to cover any injuries, lost wages, and rehabilitation costs associated with a car accident.

Currently, the states mandating PIP are [1]:

  • Delaware
  • Florida
  • Hawaii
  • Kansas
  • Kentucky
  • Massachusetts
  • Michigan
  • Minnesota
  • New Jersey
  • New York
  • North Dakota
  • Oregon
  • Pennsylvania
  • Utah

In the states of Maryland, Texas, and Washington, PIP coverage is required unless the driver signs a waiver at the time they buy the policy. This waiver is also called an exclusion agreement.

A quick example of PIP in action is, if you were in an accident in a no fault state and needed an x-ray and some medications -- the PIP component of your policy would pay these costs before any other form of coverage came into play.

When Does My Health Insurance Pick up Costs?

As a rule, medical insurance will only pay for injuries if no other insurance will cover the loss or another policy’s limits have been exhausted. This is true regardless of what type of injury was sustained.

Example:

Martin was involved in a rear-end accident recently and through that, he sustained a broken leg, concussion, and quite a bit of bruising. He is normally very diligent about his bills but he neglected to pay his insurance bill and his policy lapsed making him uninsured.

He turns to his personal health insurance for coverage of medical expenses. His personal health insurer will wait to confirm that neither Martin nor the other party has insurance that will cover anything -- then they will likely pay.

What specifically is covered will vary quite a bit from policy to policy. In the event your personal insurance is picking up the tab you will still likely have to pay for:

  1. The full amount of your deductible.
  2. Any co-payments that are a part of your health plan.
  3. Any charges that would typically be excluded from coverage.

While the above is generally true, some policies specifically exclude auto accidents, so to be certain be sure to read your policy’s language carefully.

How Does Fault Factor Into Paying My Medical Bills?

How your medical bills are handled in an auto accident injury claim also depends on whether it occurred in a no-fault state or tort (“fault”) state.

Car Accident Injury in “No Fault “ State

No fault states are states where the law says an insurance company will cover the damages of their insureds regardless of who is at fault for an accident.

There are 12 “no fault states” which includes: [2]

  1. Florida
  2. Hawaii
  3. Kansas
  4. Kentucky
  5. Massachusetts
  6. Michigan
  7. Minnesota
  8. New Jersey
  9. New York
  10. North Dakota
  11. Pennsylvania
  12. Utah

However, they payments made by the insurance companies in a no fault state are only covered to a limit . If the cost of your injuries exceed this limit you will be expected to cover the medical costs or PIP and Medpay will be applied.

Medpay is similar to PIP, but it differs in that it will only cover medical costs for you and others in an accident (not other damages such as lost wages).

Medpay and PIP also generally have $10,000 policy limits, which when exceeded, will leave you to pay out of pocket or fall back on your personal health insurance.

Car Accident Injury in “Fault” State

Fault or tort states, are states where the law says the driver who caused the car accident is responsible (or their insurance company) for paying the victim's medical bills and compensating them for any additional damages due to the accident.

(Tort states are all states that are not included in the list of “no-fault” states discussed before.)

If your accident happened in a tort state this means that the auto insurer of the guilty party will pay some or all of your medical bills. In some tort states, there is a limit to medical costs an insurer will pay. This varies but is typically around $10,000 [2].

If you exceed this limit your personal health insurance may kick in or Medicare-Medicaid (if this applies to you).

Summary:

Determining your insurance coverage and making sure that your medical bills get paid after a car accident can be a confusing and frustrating process. But it’s not as complicated as you might think, and you should now be armed with a bit more information.

Just be sure to keep the following in mind:

  • You are responsible for deductibles.

  • Your auto insurance typically pays first, and health insurance is considered secondary coverage.

  • Your personal health insurance may kick in if no other coverage exists or policy limits have been exhausted.

  • Accident injuries suffered in “fault” or “no fault” states determines who makes the payment for your medical bills.


Sources

1 - Insurance Information Institute- Report
2 -
Insurance Information Institute


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