Will Health Insurance Pay for Auto Accident Injuries? – Maybe, with a “BIG” catch!

Health Insurance Coverage of Auto Accidents - Sarasota, Bradenton, Punta Gorda

Will Health Insurance Pay for Auto Accident Injuries? – Maybe, with a “BIG” catch!

It’s not uncommon for our firm to meet with seriously injured auto accident victims, with a bare bones auto insurance plan, who are in a great deal of financial trouble with medical bills. Their reasoning is, “I have health insurance. I didn’t think I needed to spend more money on supplemental auto insurance”.

If you think like the people described above, you may be in for a BIG surprise at the worst possible time. Will your health insurance pay for auto accident related injuries? The answer is a resounding, maybe.

Health Insurance & Covered Claims

Insurance companies only pay for covered claims. Some health insurance policies have exclusions for covering injuries related to dangerous activities, such as motorcycle, ATV and jet-ski riding. Whether a claim is covered boils down to the terms of the individual health insurance policy/contract you have and what specific exclusions are contained within that contract.

Even if your health insurance plan covers your auto accident injuries, there are things to consider. First, health insurance coverage related to auto accidents, is usually secondary insurance. This means:

  • It only covers medical expenses, not lost wages. Conversely, Personal injury protection (PIP) under your automobile policy covers a healthy percentage of your wage loss.
  • Typically, all of your auto insurance coverage needs to be exhausted before your health insurance becomes primary.
  • There may exclusions under your health insurance that don’t apply to personal injury protection automobile coverage. For instance, dental repairs due to a car accident are not typically covered by health insurance. However, PIP would cover this.
  • In an era of “Catastrophic” health policies, your health insurance deductible could be overwhelming. PIP typically has a very low deductible, if any.
  • Be prepared for a very long wait while your claim is “investigated”, before your health insurance actually pays for any medical treatment.

The “BIG” Catch

Under most circumstances, if you use health insurance for auto accident related injuries, you are required by law to reimburse the health insurance company for the medical expenses they paid. This is especially true with Medicare, Medicaid and ERISA health insurance plans.

When a victim receives any settlement from a personal injury claim, rest assured, the health insurance company will be there to collect before the victim sees any compensation. PIP, however, is not reimbursed to the automobile carrier at the conclusion of the claim.

Your best bet is to purchase PIP under your automobile policy. However, if your bills exceed the available PIP, it may be necessary to run the remaining bills through health insurance. At the conclusion of the claim, it is common for remaining medical bills and health insurance liens to be negotiated by all parties involved. A lawyer skilled in handling these liens and bills can often reduce them to a manageable amount permitting the victim to receive the compensation necessary to get them on their feet again.

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