Personal Injury

Who Pays Medical Bills in a Personal Injury Case?

By Carol DiBari, Attorney
While you might expect a substantial settlement in your personal case, you are typically responsible for your medical bills in the meantime.

If you suffer injury as a result of any type of accident, even if you decide to file a personal injury claim, chances are you will probably start to receive bills for any medical treatment you've received before you get anywhere near reaching a personal injury settlement.

How to pay for these ongoing medical bills is a serious concern for many personal injury claimants. While your case may eventually yield a significant settlement or jury award, you are typically responsible for making sure your medical bills are paid in the meantime. Read on to learn more.

Ongoing Medical Treatment Related to an Accident

Regardless of the type of personal injury claim you're making, the general rule is that you are responsible for paying your own medical bills (or making sure they're paid), either through your health insurance plan, any other applicable insurance coverage, or out-of-pocket. If you are injured in an accident and have health insurance, your medical costs will be billed to your health insurance, and the insurer will pay your medical bills (and will typically be reimbursed from any settlement proceeds; more on this later).

Utilizing your medical insurance coverage is probably the most efficient way of paying your ongoing medical bills while you await the resolution of your personal injury case.

A specific car insurance coverage option known as "med pay" or "personal injury protection (PIP)" coverage is available in some states (it's also a requirement in no-fault car insurance states). A similar "med pay" option may be available to people injured as a result of a slip and fall on someone's property. If your car insurance or homeowner’s policy includes "med pay" coverage, then that coverage will pay your medical bills up to the specified policy limits. Any medical bills beyond the policy limits are your responsibility.

If you don’t have health insurance and no other insurance options are available, you will have to pay your medical expenses out-of-pocket, which could result in serious financial strain if your injuries are significant.

Exceptions: When You Don’t Have to Pay Your Medical Bills

There are some exceptions that relieve you -- even if only temporarily -- of the obligation to make sure your medical bills are paid after an accident.

Car accidents in no-fault states. There are several states -- Florida, Hawaii, Kansas, Kentucky, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania, Utah, and Washington, D.C. -- that follow a no-fault car insurance system. This means that your insurer will pay for your medical bills and certain other economic losses, regardless of who was at fault for the car accident. Of course, if your medical bills exceed your coverage limits, you will be responsible for paying the excess yourself. Learn more about what's covered and what's not under no-fault car insurance.

Medical Provider Hold Agreements. Some medical providers will put a hold on your medical bills until the personal injury case is settled. Once you do settle your case, you will be responsible for paying your medical bills out of your settlement. If your personal injury case is dismissed for some reason and you receive no compensation, you will be responsible for paying your medical bills out-of-pocket.

Pre-Settlement Loans. A plaintiff may seek a loan or advance against his or her settlement to pay for medical bills. A pre-settlement loan often requires a personal injury attorney’s cooperation, and the amount loaned -- plus any interest, of course -- will be deducted from any settlement amount you end up receiving. But again, if your case is dismissed for some reason after securing a pre-settlement loan, you will be responsible for paying back this loan out-of-pocket.

Health Insurer Reimbursement and Liens

It is important to note that once you do receive your settlement or jury award after a successful personal injury insurance claim or lawsuit, your medical insurers are entitled to make a claim against your compensation, to be reimbursed for the funds they paid out on your behalf. This right of reimbursement belongs to your medical insurer and is rooted in the principle that you cannot recover twice for the same damages. If your insurer paid your medical bills for you, then you cannot also receive compensation from the defendant for the same medical bills. Learn more about liens on a personal injury settlement.

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