Our Phila car accident lawyers get asked about medical bills quite often.
In fact, one of the first questions after a Philadelphia car accident is, who pays for my medical bills?
The answer depends on two issues, whether the injuries exceed the PIP (personal injury protection) limit of the applicable car insurance policy and whether another party bears any fault for causing the accident.
In car accident cases where the injuries are very serious, the PIP limit will get exhausted. For example, someone suffers catastrophic injuries in a car accident in downtown Philadelphia. The individual is taken to a local hospital in Philadelphia and receives multiple diagnostic tests. She also needs a major surgery that results in several days in the hospital. The costs for this single hospital stay exceed the $5,000 PIP limit. Let’s say the total bills cost $25,000, after the PIP payment of $5,000. Who pays for the remaining bills?
The answer is two-fold. Initially, the individual’s private health insurance (or Medicare/Medicaid, if applicable) would pay for the remaining hospital bills as well as any additional medical treatment costs, such as physical therapy, follow up visits, etc. Then comes the issue of whether another party bears any fault for causing the accident.
PIP coverage is one of the most commonly misunderstood types of auto insurance coverage. It is mandatory under Pennsylvania law and applies without regard to fault. This principle is known as no-fault law. Other states like New Jersey and Delaware follow the same principle.
If you are covered under any car insurance policy (except motorcycle insurance policies) and you are injured in a car accident, you are entitled to make a claim for PIP benefits under your OWN policy, or a policy you are covered under, i.e., a parent or spouse’s policy. This is true whether you caused the accident or someone else caused the accident. PIP benefits are available without regard to fault.
In Pennsylvania, every car insurance policy issued in the state must carry at least $5,000 of PIP benefits. They are available per person, per accident. So, if mom, dad and child are injured in the same car accident, and they are covered under the same insurance policy, they can all make a claim for up to $5,000 of PIP benefits.
Many Pennsylvania residents choose PIP coverage amounts higher than the minimum $5,000 amount. It’s not uncommon to see $10,000 or $50,000 PIP coverage amounts.
There are no co-pays or deductibles. Once a PIP claim is opened, all medical treatment providers bill the insurance company directly. The key is making sure that the PIP claim is opened in a timely manner. Opening a PIP claim requires the following:
If the car accident was caused by another party, the injured individual can seek financial compensation by filing a car accident lawsuit. In that lawsuit, claims can be made for medical bills, including those that were paid by health insurance, and lost wages.
In practice, here’s how this works. Let’s use the Philadelphia car accident example above, where there are $25,000 in medical bills, after PIP has paid $5,000. Of the $25,000, the individual has paid $2,000 for co-pays and deductibles. The health insurance company has paid the remaining $23,000. The individual would pay the co-pays and deductibles as they become due. If a car accident lawsuit is filed, the health insurance company could assert a lien on the $23,000 of medical bills it paid. In other words, the health insurance company is saying that it has a legal right to be reimbursed for what it paid out as a result of the car accident. Pennsylvania law allows these types of claims, known as subrogation claims. However, there are specific, complex laws that apply to these claims, which are usually filed in car accident cases.
The claims for medical bills and lost wages are purely economic losses, but what about non-economic losses, like pain and suffering? Under Pennsylvania law, whether a car accident victim can make a claim for pain and suffering, i.e., physical pain and emotional suffering, depends on a complex body of law called, limited tort.
Our auto accident lawyers handle car, truck and pedestrian accident cases in Philadelphia, the surrounding counties and New Jersey. Contact us for a free consultation.
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