Having an auto accident and dealing with mounting medical bills can be very stressful. You may assume that the at fault driver is responsible for coverage of your medical bills for treatment of your injuries from the accident. However, this is usually not the case if you were in an auto accident in Pennsylvania or New Jersey and you have auto and/or health insurance. When you have injuries that need medical treatment from an auto accident it is your own auto insurance that initially covers your medical treatment. These medical benefits are called first party, or personal injury protection (“PIP”) benefits. Auto insurers in Pennsylvania are required to provide them by law, specifically via 75 PA. CS. 1711(a). This is also true for New Jersey.
At a minimum these medical benefits must provide $5,000 in medical coverage. However you can chose to have medical benefits coverage up to at least $100,000. You can also elect to have extraordinary medical benefits coverage up to $1,100,000. Once these medical benefits are exhausted you will receive a letter from your auto insurance letting you know your auto insurance will no longer cover your medical treatment because your medical benefits are exhausted, and you should contact other sources of insurance for coverage of your medical treatment. If you have health insurance, that will cover your medical treatment going forward.
What if you do not have auto insurance, and you were a passenger in someone else’s car when you were injured in an auto accident? If you live with a family member and he or she has auto insurance, the medical benefits with that family member’s auto insurance will cover your treatment for your injuries. This only applies to family members you live with though. It does not apply to the auto insurance of a non-family member that you live with. A non-family member’s auto insurance would only provide you medical benefits coverage if you are listed as an insured under that person’s auto policy.
If you do not live with a family member who has auto insurance, and do not have auto insurance yourself, you can still get coverage for your medical treatment through automobile insurance. In this scenario, the medical benefits coverage would come from the auto policy of the motor vehicle you were in when the accident happened. So if you are a passenger in a friend’s car or were driving a friend’s car with their permission and you were in an accident, the auto policy for your friend’s car will provide you first party medical benefits coverage up to the policy’s limits.
What if you were traveling on an e-bike, moped, or other vehicle that is not required to have either insurance or medical benefits coverage, and you were in an accident with another car? If you have auto insurance for a car you own, you can receive medical benefits coverage from that auto insurance for this accident. Likewise, if you live with a family member who has auto insurance, you can receive medical benefits coverage for treatment of your injuries from that family member’s auto insurance policy. If you do not have auto insurance and do not live with a family who has auto insurance, then your medical treatment will be covered by your health insurance.
How do you receive medical benefits coverage from automobile insurance? You will have to contact the automobile insurance company that will be providing you coverage for your injuries and set up a claim with it. This will involve filling out forms about the accident, your injuries, and other sources of insurance, if any, that you have.
What medical bills are the at-fault driver (or defendant) responsible for? The at-fault driver is responsible for any out-of-pocket medical expenses you have. This includes co-pays and any medical bills not covered by some type of medical insurance. If you do not have health insurance then, you can claim any out of pocket medical expenses you owe after the medical benefits with your automobile insurance are exhausted as damages in your civil claim against the at-fault driver. If you do have health insurance and initially treat at an emergency room of a hospital after your accident, you need to make sure you give the staff at the hospital both your auto insurance and health insurance information. If you have follow-up treatment with your doctor you also need to make sure you give your doctor your auto insurance information.
Is there a benefit to having more medical benefits or PIP coverage under your auto policy? The more PIP coverage that you have the less likely you will need to rely on your health insurance to cover your medical treatment from your auto accident. Therefore, you can avoid the deductible and co-pay payments you must make with your health insurance.
The Thistle Law Firm is experienced at handling auto accident claims. If you suffered injuries from an auto accident, the attorneys at the Thistle Law Firm are here to take your call and answer your questions at 215-568-6800.