In our experience, many people do not realize that their health insurance may cover the cost of their medical care. For example, most people in automobile accident cases have PIP coverage available to them. This coverage limits the amount of medical benefits available for an automobile accident up to $10,000.00. Since medical care is expensive, it is certainly probable that the cost of that medical care could exceed the PIP amount. However, if a claimant has health insurance coverage and the doctor is on his/her health insurance plan, the physician generally has to accept the patient and charge the patient at the rate the physician agreed to accept from the health insurer. Thus, health insurance allows an injured person to continue to get the medical care they need even if the PIP benefits are exhausted.
Keep in mind, though, that the health insurer likely would have a right of subrogation, meaning that the health insurer at the time of settlement gets repaid a percentage of what it paid on behalf of the injured person. So, if the insurer paid $20.00 for a specific form of treatment, the insurer would have to be repaid only a portion of that amount.
The insurer almost universally pays much, much less than a doctor’s full charge. Thus, in an automobile accident, if benefits are exhausted and health insurance coverage is available, a claimant should take advantage of using the health insurance that they ultimately purchased.
This article does not constitute legal advice or the formation of an attorney-client relationship, and is not for re-publication without express permission of the author.