When Does My Health Insurance Pay for My Medical Bills if I Am in a Car Accident?

• September 09, 2024
• Car Accident

According to a 2023 study published by the National Highway Traffic Safety Administration (NHTSA), traffic crashes across the U.S. cost a total of $340 billion. Much of this was spent on the medical bills of those injured in crashes.

If you’ve suffered serious injuries in a car accident, funding your recovery will be one of your chief concerns. Healthcare is notoriously expensive in the U.S.; if you have health insurance, you’ll want to be able to file a claim against it to cover your costs and avoid out-of-pocket expenses. However, even if you don’t have coverage, you may be able to use Washington’s auto insurance rules to compel the at-fault driver’s coverage provider to pay your bills. We explain below how this can work.

When Does My Health Insurance Pay for my Medical Bills if I Am in a Car Accident?

There are two main types of insurance coverage that come into play following a car accident: auto insurance and health insurance. Generally, auto insurance is the first line of defense when it comes to covering medical expenses. However, there are situations where your health insurance may come into play instead of, or in addition to, your motor insurance.

Personal Injury Protection (PIP) is an optional part of all auto insurance policies in Washington (PIP is explained in more detail below). Your insurance company is required to offer PIP to you; however, you have the option of declining PIP coverage.  PIP coverage adds to the premium cost, but we highly recommend that you have PIP coverage.  Even if you have PIP, if you have serious injuries, you may exceed the limits of your PIP protection, in which case you must typically rely on your health insurance policy.

Health insurance also steps in when you do not have PIP, or when auto insurance claims are delayed or denied, ensuring that your medical needs are met promptly. Your healthcare provider may then seek repayment from your auto insurance claim once it’s approved.

Even if you have auto insurance, your health insurance might still be used first if you do not have PIP, or if your auto policy specifies that your health insurance is the primary payer. This can happen if you’ve opted for lower premiums on your auto insurance in exchange for relying on your health coverage.

It’s important to note that health insurance typically won’t cover certain costs related to car accidents, such as lost wages or pain and suffering; these are usually met by auto insurance or through a personal injury claim against the at-fault party or, if the at-fault party does not have insurance, through uninsured motorist coverage.

It’s also important to understand that you cannot legally claim two insurance payouts in relation to the same expense.

What Accident-Related Expenses Does Motor Insurance Cover?

There are a number of car accident costs that fall strictly into the scope of auto insurance rather than health insurance, such as:

• Lost wages
• Pain and suffering
• Property damage

Auto insurance may also provide for the coverage of medical costs in some cases. It does so with two main types of coverage; Personal Injury Protection (PIP) and MedPay.

Personal Injury Protection (PIP)

In Washington, auto insurance companies are required to offer PIP coverage to all policyholders. Because of this mandatory offer, many drivers in Washington opt to include PIP in their insurance policies.  Drivers are not required to have PIP coverage, but it is highly recommended.

PIP is more comprehensive than MedPay, covering medical expenses, lost wages, rehabilitation costs, and other related expenses. This makes it a more attractive option for many drivers, especially those who want broader coverage in the event of an accident.

It’s worth consulting your policy to see whether you have PIP, and what its limits are.  Your PIP coverage will pay for the medical bills, lost wages, and other related expenses before any other insurance coverage, until your policy limits are exhausted.

MedPay

MedPay is available in Washington, but it is less common than PIP. MedPay primarily covers medical expenses, and its benefits are usually more limited than those available under PIP.

Washington insurers aren’t required to offer MedPay, as they are PIP. As a result, a much smaller number of motorists in the state carry it. Again, you should check your policy to see whether you have MedPay coverage.

What Happens If You Don’t Have Health Insurance?

Washington is a “fault” state. This means that the at-fault driver is responsible for covering all the financial costs arising from an accident. So, if you get rear-ended by another driver when you’re stopped at a red light, their auto insurance company will ultimately foot the bill, not yours. You should note, though, that insurance companies often dispute liability in these situations by claiming their policyholders are not at fault. Insurance companies also dispute the amount of damages that you claim to have suffered.  In these circumstances, legal action may be the only way to pursue the compensation you need to get your life back on track.

If you have PIP, it will typically cover your medical bills up to the PIP policy limits, regardless of who is at fault. However, if you don’t have PIP or if the costs exceed your PIP coverage, you could be left paying out-of-pocket, particularly if you don’t have uninsured or underinsured motorist coverage (maybe link to UM blog).

You can try to sue the at-fault driver for the full extent of the injuries you suffer in a car accident. This lawsuit can seek compensation for all your medical expenses, including those that might have been covered by health insurance, as well as other damages like lost wages, pain and suffering, and future medical costs.

However, it’s important to note that this process can be lengthy, and the outcome is not guaranteed. If you suffer serious injuries and the other driver does not have sufficient auto insurance, any compensation you pursue may need to come from their personal assets. In more serious cases, the at fault driver may not have anywhere near the level of wealth required to cover the full extent of your expenses.  That is why we highly recommend obtaining uninsured/underinsured motorist coverage (UM/UIM).

If you have been in an accident, and have concerns about how this all may play out in your case, you should schedule a free initial consultation with one of our experienced car accident attorneys.

Hiring the Right Lawyer After a Car Accident

Insurance coverage can be very difficult to understand. Insurers use deliberately complex language, policy terms, and coverage structures to make the claims process harder to complete. Mistakes during a health or auto insurance claim following a car accident can be costly, so it’s important to have an experienced legal representative in your corner.

Contact Montoya Hinckley today to schedule a free initial consultation with one of our highly experienced car accident lawyers. You can reach us via our online contact form or by calling 509-895-7373.