AUTO ACCIDENT VICTIM'S MEDICAL BILLS

If you have been injured in a motor vehicle accident in Pennsylvania, you may be entitled to have your medical bills paid regardless of who was at fault in causing the accident. Pennsylvania law requires all motor vehicle insurance policies to contain provisions for payment of what are known as "first party benefits" to compensate, without regard to fault, those injured in motor vehicle accidents. These "first party benefits" include the right to payment, up to certain specified limits, of all accident-related bills. Even if you do not have a policy of motor vehicle insurance yourself, you may be entitled to coverage: (1) under a policy purchased by someone else who was involved in the accident; (2) as a resident relative of someone else who has a policy; or (3) under the assigned claims plan. The amount of coverage for such medical bills depends upon the policy limits of the applicable insurance, but all policies are required to provide for a minimum of $5,000.00 in first party medical benefits.

If you need an attorney and don't have one, the Lawyer Referral and Information Service can help.

Call Us Monday - Friday from 8:30 AM - Noon and 1:15 PM - 3:00 PM at (814) 459-4411.

If your medical bills are greater than the limits of the first party medical benefit provided by your policy, you may still be able to recover for such bills. In some cases, the medical bills can be paid as a part of damages to which you may be entitled to recover against the person who was at fault in causing the accident. The payment may come either from that party's automobile liability insurance policy or, if your bills exceed the limits of that policy, from the underinsured motorist provisions of your own or somebody else's auto policy. You may also be entitled to payment of these bills through your Blue Cross or similar medical insurance plan, if you have one.

Typically, when you first seek treatment for injuries sustained in an automobile accident, your doctor or other health care provider will ask you whether your injuries were motor vehicle accident related.  If you reply that they were, they will ask further questions concerning applicable automobile insurance, and will bill the appropriate company automatically. Even if your doctor or the medical staff does not ask you, however, be sure to tell them that your injuries are motor vehicle-related, so that they will know to bill the proper insurance company. Usually, payment is made without a problem and you may not even be aware who has paid the bill on your behalf or when it was paid.

Sometimes, however, an insurance company will refuse to pay a bill, contending that it did not relate to an automobile accident, that the medical services are not necessary or that, for some other reason, you are not covered under their policy for first party benefits. If this has happened, you are entitled to know the precise reason that the insurance company has refused payment. You should find out from your doctor the name of the insurance adjuster who has denied coverage, and contact that person for a full explanation of why your bills are not being paid.

If it is your own insurance company denying coverage, find out whether they contest the fact that you had a valid policy of insurance in effect at the time. Sometimes, a company will claim that, at the time of the accident, your policy had lapsed for non-payment of premium. If this is the case, you should request the details about when the company claims the policy lapsed, and if and when they sent notice to you of their intent to cancel your policy for non-payment. The law provides that if the insurance company did not adequately and properly notify you of their intention to cancel your insurance for non-payment, they are not permitted to cancel the policy, and your coverage might still be in effect, regardless of what the insurance company says.  If the company admits that you are covered under their policy, sometimes you will find that payment of medical expenses has been denied simply because the medical care provider has not provided adequate documentation of the medical services rendered. If this is the case, you should arrange for a meeting, or conference call, between the insurance adjuster, you and your medical care provider. Make sure that the insurance adjuster states specifically what further information is necessary from the medical care provider, and make sure the medical care provider understands the requirements and will supply the information requested.

Sometimes the insurance company refuses payment because it contends that either the medical treatment rendered was not reasonably necessary or because the injury for which it was rendered was not caused by the accident in question. In many such cases, you will receive notice that your case has been sent to a peer review organization to determine whether the treatment rendered by your health care provider was reasonable and necessary under the circumstances of your case.

A peer review is simply a reconsideration of your case by another doctor for purposes of gaining a "second opinion" as to whether the treatment rendered was appropriate.

If the peer review determines that the treatment was not reasonable and necessary, the insurance company does not have to pay the medical bills submitted by your medical care provider.  The law also provides that you personally cannot be billed by your medical care provider for those services either. Both you and your medical care provider have the right to request a reconsideration of the peer review report. You also have the right to have the Court make a final determination of your right to have your bills paid as first party benefits.

The rules and regulations pertaining to the payment of medical claims arising out of motor vehicle accidents are complicated and, quite frankly, often confusing. If you have any questions concerning your rights to such payment, consult the attorney of your choice for a thorough review of your options. Your attorney will help you to secure the prompt payment of the maximum amount to which you are entitled under the law.

If you need an attorney and don't have one, the Lawyer Referral and Information Service can help.

Call Us Monday - Friday from 8:30 AM - Noon and 1:15 PM - 3:00 PM
at (814) 459-4411.