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How Do Medical Bills Get Paid in a Personal Injury Case?

Plaintiffs in personal injury cases have experienced some form of bodily injury caused by the negligence of another. In order to treat their injuries, plaintiffs often incur significant medical bills. A frequent question we get during our initial client meeting is how are the bills to be paid.

Who pays the bills and when can be confusing and overwhelming, especially when the plaintiff is badly hurt and needs to focus on his/her recovery. Above all else, understand that experienced personal injury attorneys, such as those of us here at Curcio Law, will help you navigate the confusing process of getting your medical bills paid. In general, though, here’s what you need to know about how accident-related medical bills get paid.

Automobile Accident Cases

Anytime you go to a medical provider for medical treatment, the first thing that you should do is have the medical provider bill your health insurance provider. This is also true in a personal injury case. You pay for your health insurance regularly, so it is important to use your health insurance when you need medical treatment.

As a Plaintiff in a personal injury case, having the doctors and other health care professionals submit your medical bills to your health insurance company will not reduce or lower any potential personal injury settlement. Even when your health insurance is billed, the careless party that caused the injury is responsible for the full amount of the bills, regardless of how much the health insurer paid. The logic behind this is that the injured party paid for health insurance coverage, and the third party that caused the injury does not get the benefit of the injured party paying for health insurance. This is also consistent with the public policy underlying personal injury claims, which is to make the at-fault party fully responsible for the consequences of their conduct.

Medical Payments Coverage (MedPay)

A second source of payment or reimbursement of the injured party’s medical bills is provided by auto insurance policies, which include medical payment benefits coverage or “med pay.” (See Va. Code § 38.2-2201) Med pay is a very important coverage that all purchasers of auto insurance in Virginia should have. With med pay coverage, the injured party’s auto insurer will pay medical bills up to the stated amount of coverage or reimburse the injured party the amount of the medical bills up to the coverage limit.

Med pay coverage is very important for a few reasons: 1. As discussed below, the coverage limit is stackable; 2. It provides coverage to all occupants of the insured vehicle up to the stated limit; and 3. It provides coverage to the named insured on the policy and his/her family members for any injury arising from the use or operation of an automobile. Another benefit of med pay coverage is that the auto insurer cannot assert a lien on the injured party’s personal injury recovery. In order to obtain a recovery under the med pay coverage, the injured party’s medical bills and records must be submitted to the auto insurer.

Under the med pay provisions of an auto policy, the carrier is only obligated to pay or reimburse the injured party the amount actually paid by the health insurer on the same bill, and if no health insurer payment, then the usual and customary charges for the services, plus any co-pays or deductibles owed. An injured party’s auto insurance company will make payments to the injured party or directly to the medical provider. While Virginia residents buying auto insurance are not required to buy med pay coverage, all auto insurance companies in the Commonwealth must offer it as part of the insurance policies they sell.

We strongly recommend that everyone buy med pay coverage as it is inexpensive, and it helps pay an injured party’s medical bills while they await resolution of their personal injury case. Med pay only adds around $5 per month to the cost of most auto policies.

Stacked Coverage

Another very important and beneficial component of med pay is that the coverage stacks. For example, if you have $5,000 in med pay coverage and have two vehicles insured on the policy, you will have a maximum of $10,000 in medical payments coverage available to all family members and occupants of the car.

Bodily Injury Coverage

As previously mentioned, your health insurance and med pay coverage do not impact your personal injury case. In a personal injury case, the injured party is to be compensated for the full amount of their medical bills, regardless of whether the bills have been paid by health insurance or med pay coverage..

Bodily injury claims are compensable by auto insurance companies under the bodily injury coverage of the at-fault party. In the Commonwealth of Virginia, the minimum limit for auto insurance bodily injury coverage is $25,000 per person and $50,000 per incident.

If the at-fault driver does not have insurance (they are uninsured) or has less insurance than the injured party (they are underinsured), the injured party’s own auto policy’s uninsured/underinsured motorist (UM/UIM) coverage kicks in. This means that the injured party’s auto insurance company will provide coverage to the injured party up to the bodily injury limits. For example, if the injured party has $100,000 in bodily injury coverage and the at-fault party has $50,000 in bodily injury coverage, the injured party has $100,000 in coverage available to compensate him/her for their injuries. In that scenario, the at-fault party’s insurance would be liable up to the $50,000 in coverage, and the injured party’s insurance company would provide another $50,000 in coverage for a total of $100,000.00.

Unlike a health insurer or the med pay carrier, an auto insurance company does not pay out liability or UM/UIM coverage in a piecemeal fashion. Rather, the liability or UM/UIM carrier pays the injured party when a settlement is reached, or a verdict is returned in the injured party’s favor.

Premises Liability Cases

Similar to auto accident cases if you are injured on someone’s premises, the first thing you should do is seek medical attention and have the medical provider bill your health insurance company. The next source of coverage is the property owner’s med pay coverage if the policy provides such coverage. Many commercial and some residential property owners’ liability insurance policies include med pay coverage, which pays the injured person’s medical bills up to the policy limit.

Your health insurance and med pay are two sources of coverage that are available to an injured party whether or not the property owner was negligent in causing the injury. If the property owner, or an agent of the property owner, is proven negligent in causing an injury to another party on their property, the injured party would also have a personal injury claim against the property owner. In this case, the full amount of the medical bills would be included in that claim and would be paid by the liability coverage on the premises.

Are Accident-related Medical Bills Overwhelming You? Don’t Go It Alone.

Dealing with the aftermath of an auto or premises liability accident can be confusing and overwhelming, and there’s no reason to navigate it alone, especially while you are recovering from your injuries. By choosing to work with an experienced personal injury lawyer, you will have a professional ready to guide you every step of the way so that you receive the full compensation to which you are legally entitled.

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