If you are injured in a Pennsylvania car accident, your health insurance is usually not the first source of payment for accident-related medical bills. Pennsylvania auto insurance generally provides first-party medical benefits that pay covered medical expenses regardless of who caused the crash. Health insurance may become relevant after available auto medical benefits are exhausted or in other circumstances depending on your coverage.
Understanding which insurer should receive your medical bills can help prevent unnecessary delays, unpaid bills, and confusion while you recover.
MHK Attorneys helps people injured in vehicle crashes throughout Monroe County and surrounding areas understand their insurance coverage and pursue compensation when another party is responsible.
Who Pays Medical Bills After a Car Accident in Pennsylvania?
Pennsylvania requires most automobile insurance policies to include at least $5,000 in medical benefits coverage.
This first-party medical coverage pays qualifying medical bills for you and others covered by the policy regardless of who was responsible for causing the accident.
According to the Pennsylvania Insurance Department’s auto insurance guidance, medical benefits are a required component of Pennsylvania auto insurance, with a minimum coverage limit of $5,000.
Drivers can also purchase higher medical benefit limits.
As a result, when you are injured in a Pennsylvania car accident, your auto insurance coverage will often be the first place accident-related medical bills are submitted.
If you were injured because of another driver’s negligence, MHK Attorneys’ car accident attorneys can also help evaluate whether you may have a personal injury claim.
Does It Matter Who Caused the Accident?
For first-party medical benefits, fault generally does not determine whether your own qualifying medical expenses are covered.
Pennsylvania’s auto insurance system requires medical benefits that can pay covered bills regardless of fault. This means you generally do not have to wait for an insurance company to decide which driver caused the crash before using applicable first-party medical coverage.
For example, suppose another driver runs a red light and crashes into your vehicle. You are transported to an emergency room and later require follow-up treatment.
Even though the other driver appears to have caused the accident, applicable first-party auto medical benefits may initially pay qualifying medical expenses.
Fault becomes especially important when determining whether you have a separate claim against the negligent driver for damages beyond benefits otherwise paid or payable through applicable coverage.
Learn more about MHK Attorneys’ broader personal injury services if you have been hurt because of another person’s negligence.
Which Auto Insurance Policy Pays Your Medical Bills?
The answer depends on your insurance situation.
Pennsylvania law establishes an order of priority for determining the source of first-party benefits after a motor vehicle accident.
Under Pennsylvania’s Motor Vehicle Financial Responsibility Law, the general priority is:
- The policy under which the injured person is a named insured
- A policy under which the injured person otherwise qualifies as an insured
- The policy covering the vehicle the injured person occupied
- For certain people who were not vehicle occupants, coverage on a vehicle involved in the accident
You can review the statutory order directly in the Pennsylvania Motor Vehicle Financial Responsibility Law.
Because insurance situations vary, you should not automatically assume that the policy covering the vehicle you were riding in is always the first policy responsible for your medical benefits.
Does Health Insurance Pay After a Pennsylvania Car Accident?
It can, but health insurance is generally secondary to valid and collectible Pennsylvania auto first-party medical benefits.
Pennsylvania law provides that, with an exception for workers’ compensation, auto insurance issued under the first-party benefit provisions is primary. Other benefit arrangements, including certain health-plan benefits, generally operate in excess of applicable auto first-party benefits rather than duplicating them.
In practical terms, this commonly means accident-related treatment is first submitted under the applicable auto medical coverage.
Once available first-party medical benefits have been exhausted, health insurance may become an important source of payment for additional treatment, subject to the terms of the health plan.
Because plans differ, injured people should review their specific health coverage rather than assuming every medical service will automatically be paid.
What Happens When Your Auto Medical Benefits Run Out?
The required minimum Pennsylvania auto medical benefit is $5,000, although drivers can purchase substantially higher limits.
Five thousand dollars can be consumed quickly after a serious accident.
Emergency transportation, diagnostic imaging, hospital treatment, specialist appointments, physical therapy, surgery, and follow-up care can cause medical expenses to rise well beyond minimum coverage.
Once your applicable auto medical benefits are exhausted, additional bills may need to be submitted to another available source of coverage, such as health insurance.
Depending on the circumstances, you may also have deductibles, copayments, coinsurance, uncovered services, or other out-of-pocket expenses.
This is one reason reviewing your actual auto policy after an accident is important. Do not assume that you have only Pennsylvania’s minimum $5,000 benefit. You may have purchased a higher medical benefit limit.
Can You Buy More Than $5,000 in Auto Medical Coverage?
Yes.
Although Pennsylvania requires a minimum of $5,000 in medical benefits on applicable automobile policies, insurers must make higher first-party medical benefit limits available.
Pennsylvania law provides for medical benefits of up to at least $100,000 to be made available for purchase, along with certain extraordinary medical benefits above that level.
Having higher medical benefit limits can make a significant difference after a severe collision.
Drivers should review their declarations page to determine exactly how much medical coverage they purchased rather than relying on the state minimum as an assumption.
What Types of Medical Care Can Auto Insurance Cover?
Pennsylvania first-party medical benefits can apply to reasonable and necessary treatment and rehabilitation related to injuries arising from the use or maintenance of a motor vehicle.
Depending on the circumstances, covered treatment can include services such as:
- Hospital treatment
- Ambulance services
- Surgery
- Dental treatment
- Chiropractic treatment
- Physical therapy
- Nursing services
- Psychological or psychiatric treatment
- Medications
- Medical supplies
- Prosthetic devices
- Certain rehabilitation services
The Pennsylvania Vehicle Code provides additional detail about first-party medical benefits and covered treatment.
Coverage disputes can still arise over whether treatment is medically necessary, accident-related, or otherwise payable under a particular policy.
What If the Other Driver Caused the Accident?
Medical insurance coverage and a personal injury claim serve different purposes.
Your first-party medical benefits may pay qualifying bills regardless of fault. But if another driver caused your injuries through negligence, you may also have a claim against that driver.
Depending on the case, a Pennsylvania personal injury claim may involve damages such as:
- Certain medical expenses
- Lost income or reduced earning capacity
- Pain and suffering when recoverable
- Future losses related to the injury
- Other accident-related damages
What can be recovered depends on the circumstances, applicable insurance coverage, Pennsylvania law, and issues such as the injured person’s tort selection.
Pennsylvania law also prevents an injured person from simply recovering the same benefits twice. Amounts that have been paid or are payable through applicable benefits can affect what may be recovered from an at-fault party.
An attorney can evaluate the available insurance policies and damages rather than looking only at the medical bills themselves.
What If You Have Limited Tort?
Pennsylvania drivers generally select either limited tort or full tort when purchasing automobile insurance.
Limited tort can restrict the ability to recover certain non-economic damages, such as compensation for pain and suffering, unless an exception applies.
However, selecting limited tort does not mean that you lose your first-party medical benefits.
The Pennsylvania Insurance Department explains that limited tort policyholders can still recover out-of-pocket medical and certain other expenses even though their ability to pursue some non-economic damages may be restricted.
Whether an exception to limited tort applies is a separate legal issue and can depend on the facts of the accident and the nature of the injuries.
What Should You Do With Medical Bills After a Car Accident?
Keeping your insurance information organized after an accident can reduce billing problems.
Consider these steps:
- Tell your medical providers that your injury resulted from a motor vehicle accident. Accident-related bills may need to be processed differently from ordinary healthcare expenses.
- Identify the applicable auto insurance policy. Your own policy may be first in priority even if you were injured while riding in another vehicle.
- Check your medical benefit limit. Review your declarations page to determine whether your coverage is $5,000 or a higher amount.
- Keep copies of bills and insurance correspondence. Save explanations of benefits, denial letters, invoices, and notices showing how much coverage remains.
- Notify your health insurer when appropriate. Once applicable auto benefits are exhausted, additional medical expenses may need to be processed under your health plan.
- Avoid ignoring bills because an injury claim is pending. A personal injury case does not automatically stop providers from seeking payment.
- Speak with an attorney when coverage or liability is disputed. Questions can become more complicated when multiple insurers, serious injuries, uninsured drivers, or substantial medical expenses are involved.
Can the Other Driver’s Insurance Pay Your Medical Bills Immediately?
People are sometimes surprised to learn that the at-fault driver’s liability insurer is not necessarily the insurer that immediately pays their ongoing medical bills.
Pennsylvania’s first-party system generally means applicable medical benefits are used first for qualifying treatment.
A bodily injury claim against an at-fault driver is different. That claim may address recoverable damages arising from the accident, but the claims process can take time and may involve questions about liability, the extent of the injuries, insurance limits, and the value of the claim.
For that reason, injured people should not postpone necessary treatment because they are waiting for the other driver’s insurer to pay individual medical bills.
What If the Insurance Company Refuses to Pay a Medical Bill?
An insurer may dispute a bill for several reasons, including whether:
- The treatment is related to the accident
- The treatment is reasonable and necessary
- The correct insurer received the bill
- First-party benefits remain available
- The provider supplied sufficient documentation
- The charge complies with Pennsylvania requirements
A disputed medical bill does not necessarily mean the expense can never be covered.
MHK Attorney Michael B. Kaspszyk has extensive experience handling vehicle accident claims, including matters involving auto insurers that refuse to pay medical bills, lost wages, or vehicle repair expenses. Learn more about Attorney Michael B. Kaspszyk and MHK’s personal injury representation.
Talk to a Pennsylvania Car Accident Attorney About Medical Bills and Insurance
Car accident medical bills can become confusing quickly, especially when auto insurance, health insurance, and a claim against another driver overlap.
In Pennsylvania, applicable auto medical benefits are generally the first source of payment for qualifying accident-related medical treatment. Health insurance may become relevant after those benefits are exhausted, depending on your coverage and circumstances.
If you have been injured in a car accident, MHK Attorneys can review the accident, applicable insurance policies, medical expenses, and potential claims for compensation.
MHK Attorneys represents personal injury clients throughout Monroe County and surrounding areas, with offices in Pocono Summit, Stroudsburg, and Brodheadsville.
Contact MHK Attorneys to schedule a free consultation about a Pennsylvania car accident claim.