1st Mar 2016
Being involved in a car accident is a traumatic experience, in and of itself. But, if you require significant medical treatment, surgery and/or a lengthy hospital stay, this life-altering event can leave you reeling over the long-term impact on your finances. Fortunately, there are a number of sources of medical coverage that exist; so, it is a good idea to be aware of what is or could be available to you, in the event of an accident.
If you are injured in a motor vehicle accident in Pennsylvania, regardless of whether the accident was your fault or another driver’s, assuming that you are not “in the course and scope of your employment,” the first level of medical coverage available to you will be through your own automobile insurance policy (if you do not own a vehicle, you could be eligible for medical coverage under the policy of the vehicle in which you are riding at the time of the accident). By law, this coverage must be at least $5,000.00, although I recommend that you carry no less than $50,000.00. Your auto insurance carrier also gets the benefit of paying medical expenses pursuant to legislation named Act 6, which means that, in accordance with the formula set forth in the law, the carrier pays medical bills at a reduced rate, which providers must accept as payment in full.
If you do not have access to medical coverage through an automobile insurance policy, or if you exhaust the benefits to which you do have access, the next level of coverage implicated is that through your health insurance carrier. If health insurance pays for medical expenses that result from an accident caused by the fault of another, depending upon the type of plan it is, the carrier may have a right to reimbursement through subrogation or asserting a lien. This means that, if the health insurance coverage comes from a self-funded ERISA plan, if you make a recovery against an at-fault third party, the carrier will have a right to be paid back out of the settlement monies you receive.
If you do not have access to medical coverage through an automobile insurance policy or private health insurance carrier, if you meet certain eligibility requirements, you can receive assistance with paying your medical bills through government programs offered by the Pennsylvania Department of Welfare, Medicaid or Medicare.
If none of the above avenues of medical coverage are available to you, there is another way to receive treatment pending the outcome of a bodily injury claim emanating from another’s negligence. Some medical providers will continue to treat you even if you do not have coverage, pending the outcome of the claim, but only if you are represented by an attorney who confirms for the provider (of course, with the client’s consent) that its balance will be satisfied out of any settlement monies. If this is the case, the attorney can claim these unpaid medical bills as special damages, or economic losses, suffered at the hands of the at-fault party and seek to recover them as part of a settlement.
If you are injured in a car accident while driving (or as a passenger) for work-related purposes, regardless of whether the accident was your fault or another driver’s, the first layer of medical benefits available to you should be through Pennsylvania’s workers’ compensation system. Your eligibility for this coverage is dependent upon the facts and circumstances surrounding the accident, and the best person to evaluate this situation is an experienced personal injury and workers’ compensation attorney. If you are entitled to medical benefits under the workers’ compensation law, the workers’ compensation insurance carrier will have a statutory right to assert a lien against any third-party recovery you make. Again, this means that, if you achieve a settlement from the person who caused the accident (i.e., that person’s automobile insurance carrier), you will be required to reimburse the workers’ compensation carrier, in the amount it paid, from the funds you receive, pursuant to a specific formula set forth in the law.
The bottom line in all of this is that seeking out and availing yourself of the appropriate medical coverage after being injured in a motor vehicle accident—and your duties and obligations, thereafter, should you make a third-party recovery—can be incredibly complicated. At Georgelis Law Firm, we deal with these intricacies every single day in our practice and have mastered the ability to navigate through this maze with skill and efficiency. We handle all aspects of these claims, so that our clients get the treatment that they need, when they need it and without obstacles or having to cut through the usual insurance “red tape.” Call us to discuss your claim, free of charge.