Health Insurance: Auto Accident Injuries Covered?

If you've been injured in a car accident, you may be wondering how you're going to pay for your medical treatment. The good news is that, in most cases, your health insurance will cover at least some of the costs associated with your injuries. However, the specifics of what is covered and when it is covered can vary depending on several factors, including the type of health and car insurance you have, the state you live in, and who was at fault for the accident.

Health insurance covers car accident injuries

In most cases, auto insurance policies are the primary source of coverage for car accident injuries. This is because all drivers are required to have basic liability car insurance coverage, and medical bills related to car accidents are typically paid up to the at-fault driver's policy limits. However, in no-fault states, Personal Injury Protection (PIP) and Medical Payments (MedPay) coverage may be used to pay for medical bills following car accidents, regardless of fault. PIP covers medical bills and lost income, while MedPay covers only medical bills.

If auto insurance coverage is insufficient or unavailable, health insurance policies typically serve as secondary coverage for car accident injuries. This means that health insurance will cover any remaining medical expenses after auto insurance coverage has been exhausted. However, health insurance policies may have specific restrictions, such as in-network or out-of-network distinctions, co-pays, and deductibles, that can impact the extent of coverage.

It is important to note that health insurance providers may have the right to seek reimbursement for claims paid if the insured individual receives a settlement from the at-fault driver or another source. This is known as subrogation, and it allows health insurance companies to recoup their expenses.

In summary, while health insurance typically covers car accident injuries, the interplay between health insurance and auto insurance can be complex, and it is important to carefully review the specific provisions and limitations of both types of insurance policies to understand the full extent of coverage.

Auto insurance pays first

Auto insurance is typically the primary payer for injuries sustained in a car accident. This means that the auto insurance company pays first, and health insurance covers any remaining costs.

The specific situation, however, depends on the laws in your state and who is at fault for the accident. If you live in a no-fault state, your auto insurance will cover your medical expenses, regardless of who caused the accident. In this case, you would file a claim with your car insurance company directly, and your health insurance would be secondary.

If you live in a fault state, on the other hand, the situation changes. If you are at fault, neither your policy nor the other driver's policy will cover your medical bills unless you have chosen to add personal injury protection (PIP) or medical payments coverage as an option. If the other driver is at fault, their liability insurance will cover your medical expenses, but this can take time as determining fault is often a lengthy process.

In general, auto insurance coverage that will pay your medical bills quickly and without a deductible is preferable to health insurance, which usually involves deductibles and copays. Auto insurance coverage can also be used to pay the accident-related medical bills of other people, such as family members and passengers who may not have their own car insurance.

Additionally, if you have health insurance with a high deductible, opting for higher auto insurance limits can be beneficial. While auto insurance is typically the primary payer, having additional auto insurance coverage can help cover any out-of-pocket expenses that your health insurance may not fully reimburse.

Health insurance pays second

Health insurance does pay for car accident injuries, but it is usually the second option to be billed after auto insurance. When a health insurance provider pays for medical bills first, they will turn around and file a claim against the car insurance company.

In the case of auto accidents, auto insurance typically pays for treatment until the available coverage limits are exhausted, and then health insurance kicks in to pay for the remainder. This is because auto insurance is considered "primary" insurance in the case of auto accidents, while health insurance is considered "secondary".

The "primary" or "secondary" question is answered by the fine print of the different policies in place. If, for whatever reason, a health insurance policy paid medical bills first, the health insurer will turn around and make a claim against the car insurance company that insures the at-fault driver.

In the case of auto accidents, there are two main types of auto insurance that might cover injuries: personal injury protection (PIP) and medical payments (MedPay). PIP covers medical bills and lost income, while MedPay covers only medical bills. Both typically pay out quickly, but while MedPay rarely requires a deductible, PIP often does.

No-fault insurance

In no-fault states, your own insurance company will pay for your medical expenses and lost wages, regardless of who caused the accident. This means that in the event of an accident, you submit your claim to your insurance company, which will then compensate you for certain financial losses related to your injuries. This can include lost income (up to a certain dollar limit) if you're unable to work, the cost of replacement services if your injuries affect your ability to do housework or drive, and funeral costs if someone died as a result of the accident.

The benefit of no-fault insurance is that the process for submitting a claim is straightforward, and you don't need to prove who was at fault for the accident. However, there are limitations to this system. No-fault insurance does not cover vehicle damage claims, and there is a cap on the maximum payout, which is typically $50,000. Additionally, no-fault insurance does not provide compensation for pain and suffering or emotional distress.

In certain circumstances, no-fault states may allow individuals to step outside of the no-fault system and file a claim or lawsuit against the at-fault driver. This typically occurs when the accident caused ""significant" injury, as defined by state law, or when the accident resulted in medical bills above a certain dollar threshold. Each no-fault state has its own definition of what constitutes a serious injury, and these definitions are used to determine whether an individual can pursue legal action outside of the no-fault system.

Personal injury protection (PIP) and medical payments (MedPay)

Personal Injury Protection (PIP)

PIP is a comprehensive no-fault coverage that is available immediately after an accident and covers various expenses. It provides coverage for medical costs, lost income, child care, household services, survivors' loss, and funeral expenses. The coverage limits vary between states, but can include ambulance fees, hospitalisation, nursing care, medication, psychiatric care, rehabilitation, prostheses, dental care, optical treatment, and chiropractic services. PIP also covers 80% of lost wages and, in some cases, the cost of temporary employees if you're self-employed. Additionally, it can pay for essential services such as child and lawn care for unemployed individuals. PIP does not compensate for pain and suffering, and in some cases, there may be a deductible.

Medical Payments (MedPay)

MedPay is similar to PIP but is much less comprehensive. It is optional in all but two states and covers medical expenses for the insured, other listed drivers, household members, and passengers. MedPay can function as primary medical coverage or supplement your existing health insurance, covering deductibles and co-pays. It pays medical costs quickly, regardless of fault, and does not have a deductible or co-pay. MedPay also covers you if you are injured as a passenger in someone else's vehicle, while using public transportation, or as a pedestrian or cyclist. The typical payout limit for MedPay is between $5,000 and $10,000 per person.

PIP vs MedPay

While both PIP and MedPay cover injuries and medical expenses, PIP provides more comprehensive coverage, including lost wages and other costs related to the accident. MedPay, on the other hand, is an optional add-on with more limited coverage. PIP is obligatory in most no-fault states, while MedPay is optional. PIP costs vary significantly between states, ranging from $2,500 to unlimited medical expenses and permanent injury benefits of up to $250,000. MedPay, on the other hand, is relatively inexpensive, typically adding about $5 per month to your premium.

Frequently asked questions