Will My Health Insurance Cover Car Accident Injuries?

After a crash, getting the medical care you need is crucial

When you're involved in a car accident, you may be immediately concerned about getting adequate medical treatment for any injuries sustained. In most cases involving negligence, the at-fault party’s insurance company would cover the cost of current and future medical bills, but they won’t pay until your case is resolved, which may be months or even years away. To get medical treatment in the meantime, you may need to turn to other options, including your own health insurance coverage.

Getting medical care should be your top priority after a car wreck. If you need help getting your medical bills paid, the car accident lawyers at Smith & Hassler would be glad to help.

The high cost of medical expenses after a car accident

The wreck itself may have been over in moments, but the effects on your health and well-being can last a lifetime. Depending on the type and extent of your injuries, you may have extensive medical expenses, including but not limited to:

• Ambulance Fees: Immediate medical attention often requires ambulance transportation, which comes with associated costs that can be substantial.
• Hospital Bills: Emergency room care, surgeries, diagnostic tests, and hospitalization expenses can quickly accumulate, forming a significant portion of the victim’s medical costs.
• Surgery and Medical Procedures: Complex injuries may necessitate surgical interventions and various medical procedures, all of which have their own associated costs.
• Medications and Medical Devices: Prescription medications, medical equipment, and assistive devices can be essential for recovery but can also be expensive.
• Physical Therapy: Many accident victims require physical therapy for rehabilitation, which involves ongoing costs.
• Follow-up Doctor's Visits: Continual monitoring and follow-up appointments with healthcare providers are common, incurring additional expenses.
• Home Health Aides and In-Home Care: Severe injuries may require in-home care services, further adding to the victim’s overall medical expenses.

The full cost of your medical treatment can be tens of thousands or even hundreds of thousands of dollars. Moreover, if you have a long-term or permanent injury, you may have significant future medical expenses as well.

Insurance is supposed to cover those medical bills, but that doesn’t mean the process of getting them paid is easy. Depending on the situation, there are several types of insurance coverage that can apply to your medical expenses, and insurance companies may dispute what they cover and how much they have to pay.

Types of insurance coverage that can apply to medical bills in Texas

Since Texas is an at-fault state, the at-fault driver’s insurance company is ultimately responsible for paying for your medical expenses, as well as lost wages, property damage, and other crash-related damages. But, again, it could take months before you get a settlement offer from the at-fault driver’s insurance company. They won’t pay for anything while your case is pending.

Moreover, what if you were involved in a crash with an uninsured driver? What if the driver who hit you fled the crash scene and was never identified? In these cases, you can file an uninsured motorist (UM) claim with your own car insurance company, if you have UM coverage. Insurance companies in Texas are required to offer UM. If you wish to reject it, you must do so in writing. UM covers your medical expenses, lost wages, and property damage up to the policy limit.

Additionally, insurance companies in Texas are required to offer $2,500 in personal injury protection (PIP). Many insurers offer higher limits as well. As with UM, you are not required to accept PIP, but if you don’t want it, you must decline in writing. If you decline PIP, the insurance company may also offer medical payments coverage (MedPay) as an alternative.

Either PIP or MedPay will cover your medical expenses up to the policy limit; the main difference is that PIP also covers certain other expenses not included in MedPay. PIP and MedPay are types of “no-fault” insurance, which means they will cover medical expenses no matter who caused the accident.

Finally, as with any other injury or illness, your regular health insurance (if you have it) may cover car accident injuries. (If you don’t have health insurance, see our previous article on other options to cover your medical expenses.)

What is the role of health insurance in car accident claims?

Health insurance can cover medical expenses related to a car accident, but it's important to check your policy. Some health insurance plans may have clauses that limit coverage for crash-related injuries, expecting auto insurance to be the primary payer. Your health insurance carrier may also dispute whether a particular type of treatment is covered or the amount they are willing to cover.

In addition, health insurance usually has co-pays, deductibles, and other out-of-pocket expenses that may apply. These out-of-pocket expenses can add up, so it’s important to understand your health insurance plan's structure.

Do I have to pay back my health insurance company when my car accident case settles?

Most health insurance contracts in Texas contain “subrogation clauses,” which essentially say that the health insurance company can demand reimbursement if a third party (such as the at-fault driver’s insurance company) pays for your medical expenses. The insurance company can even file their own lawsuit to pursue the reimbursement they are entitled to receive.

However, that doesn’t mean you necessarily have to pay back your health insurance company for everything they paid for. The specifics of reimbursement depend on whether you have private insurance, Medicare, or Medicaid, as well as the language of your policy and the way your car accident claim or lawsuit is resolved. In many cases, your attorney may be able to negotiate with your insurance company to accept a lesser amount of reimbursement, which means more money from your car accident claim stays in your pocket.

How can a Texas car accident attorney help me get medical care?

Car accident claims involving the use of health insurance coverage are often complex and difficult to navigate. The insurance companies deal with these situations every day, and they know how the system works. You need an experienced car accident attorney on your side to level the playing field.

The Texas car accident lawyers at Smith & Hassler, Attorneys At Law understand how injury claims work, including those involving health insurance coverage. We’ll be glad to go over your legal options and learn more about your case during a free consultation. We’ll also answer any questions and address any concerns you may have. Contact us online or call us to schedule your free legal consultation.

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