Anatomy of an Auto Accident Injury Claim

As an accident injury attorney, one word I often hear from clients is “overwhelming”. One of the biggest reasons people who have been injured in an accident eventually seek assistance from an attorney is because they are overwhelmed. The goal of this article is to give a brief overview of the injury claim process in general, as well as the different types of insurance coverage usually available. Often a situation becomes less overwhelming when you can see the forest through the trees. Bear in mind this is an overview. If you have been injured in a car accident, you should speak with your legal counsel regarding the specific facts surrounding your situation, as well as the applicable laws of your state.

ACCIDENT

You’re on your way to work, listening to Mike and Mike in the Morning while sitting in traffic when all of a sudden, WHAM! You are rear-ended by a 17 yr-old texting on their way to school. Initially, you are stunned. It takes a minute for you to realize what has just happened. You get out of the vehicle to assess the damage and make sure everyone is okay. You chastise the knucklehead kid behind you for not paying attention to the road, but at the same time, you assure him everything is going to be fine. It’s not until five hours later that you notice the sharp pain that shoots down your arm when you turn your neck to the side. You try to ignore it and assume it will subside after a few days; however, a month later the pain is still there and not showing any sign of improvement.

INSURANCE

Immediately following the accident, you were contacted by the insurance company for the kid who rear-ended you. You voiced your concern regarding the pain in your neck and arm, and you know a claim has been set up with the at-fault liability carrier, but you are receiving countless bills in the mail for the medical treatment you have received thus far, and you are not sure when the bills will be paid, what to do or what happens next?

Health Insurance

One of the most important things when dealing with an injury claim is knowing what coverage you have available to you. Aside from the auto coverage for the person who caused the accident, the first coverage you have available to you is your health insurance coverage. Many people are reluctant to have their medical bills processed by their health care insurance provider following an accident. The failure of injured parties to submit their bills to health insurance is due to misunderstanding as to how the claims process works, but this failure is also due in large part to the encouragement of health care providers. Many health care providers encourage patients not to have their bills submitted to health insurance in the hopes the provider will be able to recover more if they are paid directly from the auto liability carrier. Health insurance carriers have negotiated reduced rates with health care providers, and if the providers submit their patients’ bills to health insurance, they will be forced to accept a contractual reduction in their price for services rendered.

In most cases, you want your bills to be submitted to health insurance. First, because submitting your bills to your health insurance carrier will help keep you from being sent to collections. Most injury settlements are paid all at once. In other words, the auto carrier providing coverage will not pay your bills as you receive treatment. The liability carrier will only pay once you have settled your claim, or you have won a verdict in your favour at trial. Injury claims typically go on for months if not years. Having your bills submitted to your health insurance carrier will help prevent you from being sent to collections.

The second reason you want your bills to be processed by your health insurance carrier is the contractual reduction. By your medical bills being submitted to health insurance, you get to take advantage of the contractually adjusted rates negotiated on your behalf.

The third reason to have your bills processed by your health insurance carrier is subrogation. Subrogation, when it comes to an injury claim, has to do with your health insurance carrier’s right to be reimbursed for any medical payments that were made on your behalf for treatment of injuries sustained in the accident. There are various laws regarding subrogation which vary from state to state; however, there are times when your insurance carrier is not entitled to full reimbursement or reimbursement at all. In the situation where your carrier is not entitled to repayment, submitting your bills to health insurance can save you thousands of dollars.

Medical Payment Coverage or “Medpay”

Medical payment coverage commonly referred to as “med pay”, is the coverage you may have with your auto insurance carrier which provides for payment of medical bills in the event you or someone in your vehicle is injured in an accident. If available, medical payment coverage provides for payment of medical bills regardless of who was at fault for the accident. Like health insurance, a med pay carrier may be entitled to subrogation when your injuries were caused by the negligence of another party. And like health insurance, there are also certain situations in which subrogation is not necessary, or not allowed.