Medical Care After an Accident or Personal Injury
Question: How do I go about getting medical care after an auto accident? Do I need an attorney or lawyer to help with my personal injury case or claim?
Often, obtaining medical care after an auto accident injury can be one of the more confusing issues to people who have been injured in an automobile collision.
Topics of Interest:
Attorney's Fee in injury cases
Settling Injury Claims
Adjuster is Delaying Payment and "Investigating" Claim
Medical Care After an Accident
Notice of Hospital Lien Against Case
Should I Use My Health Insurance After an Accident?
Multiple Car Accidents and Injuries
What You Can Recover in Injury Cases
Many people assume that if the other driver was at fault, the automobile insurance company will pay for the medical care after an auto accident injury to treat their injury much like a health insurance policy would. This is a FALSE assumption that the insurance adjuster will often mislead you into believing - or allow you to believe in order to delay your treatment and lower their costs.
If you play the insurance adjuster's game, he will delay and delay until enough time has passed. Once enough time has passed, the adjuster then claims "its been so long since the accident, how do we know your injury is related to the accident we are handling?" They delay and then lower the boom on you when it is too late for you to do anything about it - too much time will have passed, and you have made it difficult to show the relationship of your injury to the accident in question. Don't fall into this trap.
Do NOT wait for the automobile insurance company to refer you to a doctor – they won’t. Insurance company adjusters string you along, making you believe that they are going to help you out, and then once you have waited a sufficiently long time without ever seeing a doctor, they will claim “How do we know your injury was caused by this collision?” “You have waited such a long time to get treatment, that we have no way of knowing that your injury was caused in the collision, or if it was caused by something else. So we aren’t going to pay for any treatment.” They don’t care that it was them stringing you along that caused the delay in your getting treatment. All they care about is that you can’t prove your claim any longer, and that fact allows them to avoid payment. That is the bottom line – to avoid payment if they can.
Your waiting around for the automobile insurance carrier to “refer you” to a doctor has now backfired on you, and they have used your lack of knowledge of how automobile insurance works against you. This is done intentionally by auto insurance companies every day in order to avoid paying anything at all on personal injury cases.
So, you may ask, how do I get medical care after an auto accident? Just treat it like any other injury. There are no special rules to obtaining treatment. Unfortunately, often hospitals, doctors, and other health care providers don't tell you this up front. There are many reasons for this. Doctors and hospitals want to be paid as much as they can. Often, they don't want your health insurance, they want your settlement proceeds. Why? Because your health insurance gets "contractual discounts" - meaning the doctors have signed a contract with your health insurance company agreeing to take a fraction of what their actual bill is. If they can get the settlement proceeds instead, then they get more money. The problem with this approach is that your settlement is not guaranteed. You are trying to recover against someone else's liability insurance. They may deny the claim outright, claiming their person didn't do anything wrong (even though they did). If you are forced to take the case to trial, you are not guaranteed to win - there is always a risk of losing when dealing with a jury trial. You MUST make it clear to your doctor, hospital, or other health care provider that if they don't use your health insurance, they do so at their own risk. Insist that they use your health insurance, you do not want your credit damaged due to the delays involved in getting a settlement.
The automobile liability insurance company will not pay you until your case is ready to settle. This means that once you are done treating for your injury, and you have obtained ALL of your out of pocket expenses and descriptions of your injury, and descriptions of any future out of pockets you are likely to incur, you are ready to try to settle the case. When you send your settlement demand in, the insurance company may want to put the blame on you, or someone else, and try to only offer you a percentage of the claim. This treatment of your injury, and negotiation may take many months. In the mean time, your doctor or hospital will send your bill to collections - damaging your credit. A Dallas accident injury lawyer will be able to help guide you through this situation.
Additionally, facts may come forward during this time you are treating and negotiating, that allow the insurance company to come back and say "actually, there is no insurance coverage here" - due to the accident description (intentional acts are not covered), or due to who was driving (some drivers are excluded from driving certain vehicles - and if that driver was driving the car, the insurance company does not have to pay the claim - some insurance companies are very sloppy in this type of investigation, and will "discover" some fact that gets them out of coverage very late in the claim. The Texas Supreme Court has allowed insurance companies to get away with this. So even if you think liability is clear, and you think "they paid for the car, so obviously there is coverage" . . . not so fast!! They still have outs they may try to use. You need to protect yourself - you never know if and when an insurance company will drum up a reason to not pay your claim. Get your bills paid by your health insurance immediately to protect yourself and your credit. Medical providers use aggressive collection agencies who will ruin your credit.
Use Your Health Insurance:
You must go to your own doctor to get treatment. I always suggest going through your own health insurance policy if possible. This way your medical bills get paid, and you do not run the risk of the hospitals, ambulance, or treating doctors turning you in to the credit bureaus or filing suit against YOU for not paying your bill. Remember, regardless of who caused the collision, the medical bills are your medical bills. You must take the steps to ensure they get paid promptly.
The only way to guarantee they get paid promptly is to have all your medical providers submit your bills to your health insurance.
Your Health Insurance Will Get Their Money Back:
You think that you aren’t allowed to use your health insurance . . . wrong! In fact, you must go through your health insurance if you want to guarantee the bills are paid. Your health insurance company will send your attorney and the automobile insurance companies involved a notice that they are filing a notice of “subrogation” against any claims regarding the automobile collision. Subrogation is an insurance term meaning collections. They will “collect” against the automobile insurance claims to get their money back – so they are not out any money . . . unless for some reason the automobile insurance does not owe the claim, which means you did the right thing by using your health insurance anyway . . . because the automobile insurance was not going to pay it anyway.
If your health insurer asks you to attempt to submit your medical bills to the automobile liability insurance, remind them that you do not have a contract with the other person’s liability insurance. This means that they have no contractual obligation to pay your healthcare bills. The only “contract” you have is with your own health insurance company, and they are contractually obligated to pay for your healthcare bills, regardless of whether it happened in an auto collision, a fall at the park, or caused by any other reason.
There are a multitude of reasons that the automobile liability insurance company for the other driver may decide to NOT pay your bills. The following are extremely common excuses used every day by ALL liability insurance carriers to avoid paying:
1) The liability insurance company will decide they are not going to cover the claim because their driver didn’t pay his premiums, or that the person who was driving the other car was an “excluded driver” who was not supposed to be driving (so no coverage);
2) The other driver’s insurance company will claim that their driver changed his story after he left the scene of the collision and now claims that YOU caused the collision, and so now they are going to stop paying for anything;
3) They will claim that what you told them about how the collision occurred proves that you are at least partially to blame (if not solely to blame) – so they are only going to pay half of your bills – since they believe you were at least half at fault for not moving out of the way of their driver when you could have. If you had been paying attention, you would have noticed that their driver was texting and driving and could not see you stopped in traffic. If YOU had just looked up, you could have easily just moved your car a few feet and avoided the whole thing. Therefore YOU are half to blame. (Don’t laugh – I hear this kind of logic coming out of adjuster’s mouths daily . . . I know you think I’m kidding, but I’m not . . . seriously, they will pull this kind of logic on you – and they will do it with a straight face because they do it every day, so they are used to using this twisted logic – and actually start to believe the BS they are spouting);
4) The other driver’s insurance company will claim that your treatment you are receiving for your accident injury is due to some preexisting condition (or due to some subsequent condition) – and that it wasn’t caused by the collision, so they aren’t going to pay for it;
5) The other driver’s insurance company will claim that you are exaggerating your accident injury and because of that, they won’t pay for it;
6) The other driver’s insurance will claim that your treating doctors or their facilities billed way too much, and they won’t pay for it;
7) The other driver’s insurance company will claim that your doctors over treated you, and performed procedures on you that were unnecessary, so they won’t pay for it;
8) They will claim that because you had health insurance, you should have used the health insurance in order to get the bills reduced contractually. Therefore they are only going to pay what your health insurer would have paid (often 50% or less of what the billed amount is). The problem with this logic is that if you don’t use your health insurance, you DON’T get your bills contractually adjusted. This means the hospital and doctors want the full amount of the bill without contractual adjustment. But that doesn’t keep the automobile insurance company from trying to claim that you should have used your health insurance in order to get the contractual adjustments - to keep the costs down.
The list of excuses automobile liability insurance companies use to avoid paying your medical bills goes on and on. If you want your bills actually paid, you had better submit them to your health insurer and insist that they pay and that if they want their money back, to submit their paperwork to your attorney and the automobile liability insurer to get paid back if and when the claim may be settled. The Law Office of Doug Goyen is a Dallas accident injury lawyer that understands how to handle all the insurance issues involved in your case. As you can see, it is complicated, and intertwined. You need someone with experience handling these issues to ensure you receive the compensation you need on your case.
How Liability Insurance Really Works:
To understand why the other driver’s automobile insurance is not going to pay your medical bills as you go to the doctor, you have to understand how “liability” insurance works. The first thing you need to do is pull out your own liability insurance policy and read what the “liability coverage insuring agreement” actually says.
Automobile liability insurance policies say:
“We will pay damages for bodily injury or property damage for which any covered person becomes legally responsible because of an automobile accident. . .”
Please make note of the words “legally responsible”. The only way someone is “legally responsible” for anything is if there is a judgment against them. This means that if you want to force the insurance company to pay you, that you must file a lawsuit against their “covered person”.
Again, look at the language above – you don’t sue the insurance company to force the liability insurance to pay, you have to sue the “covered person” and obtain a judgment against them. Once you have a judgment against the “covered person” and the judgment is final, then you can force the hand of the insurance company . . . as long as the case is beyond the appeals stage.
Most automobile insurance companies will try to "settle" a case prior to you filing a lawsuit. But this is not legally required, and the insurance company knows they aren't legally required to settle your case if they don't want to. This leads to automobile insurance adjusters acting outrageously in the negotiation process when dealing with people who do not have attorneys. Because they know you cannot force them to pay without a judgment, they will offer low amounts. They will keep information from you that would help you understand what the full value of your claim is, and what the full amount you actually owe is (in order to settle with you for less than what you need to pay your medical bills from the collision).
Without an attorney, the insurance adjuster knows that you cannot obtain a judgment against them. This means that you cannot force them to pay anything at all - since it is highly unlikely that an individual without an attorney can obtain a judgment against an insurance company that has a full staff of in-house attorneys who specialize in defending against lawsuits in order to avoid paying if at all possible. If the insurance company doesn't think you will get a lawyer to protect your rights, they don't feel any pressure to pay you what you are owed or even what you are out of pocket. If your collision was in the Dallas area, they will only feel the pressure if you hire a Dallas accident injury lawyer - this is the only way to ensure they treat you fairly in your case.
So When Will The At Fault Driver’s Insurance Pay?
The way liability insurance works is that when you are ready to settle your entire case for one lump sum, then it is time to start talking to the liability insurer about settlement of your accident injury.
The timing of this depends on each individual case. If someone goes to the emergency room, but does not go for follow up treatment, and will not go for follow up treatment, that person is probably ready to start talking about reaching some sort of settlement much sooner than another person who has an injury that requires surgery, or physical therapy of some sort to heal properly.
If you have an injury that takes time, surgery, or therapy of some sort to heal, you will likely not be ready to attempt to settle your case until you are done treating and have recovered, or get to the point where further major medical procedures have been exhausted, and you are to the point where you are just maintaining your current condition. In other words, you aren’t back to where you were before, but you aren’t going to get any better any time soon, regardless of medical treatment. At this point, you are ready to start talking settlement.
There are some exceptions to the rule of waiting until you are done treating to start settlement negotiations. One of those examples is when you have multiple injured people, but only one automobile insurance policy. If this is the case, if you wait, and the other injured people get their claims in before you get your claim in, their settlements may use up all the money that is on the insurance policy.
Remember, liability insurance policies have “limits”. This means that they will only pay up to a certain amount of money for any particular collision or incident. Once they have paid the full amount of liability limits for the collision in question, then they will not pay any further claims on that collision or incident in question. So if you are last to submit your claim, you run the risk that the insurance may be used up before you submit your claim, meaning that regardless of fault, you receive no money for your bills – because there is no money left to be paid.
Damages Often Recoverable in Personal Injury Cases Include the Following:
Past and future medical bills, past and future lost earning capacity, past and future lost income, past and future physical impairment, past and future disfigurement, past and future mental anguish, past and future pain and suffering, property damage, loss of use of your property - such as rental car bills, storage, total loss of property, diminished value of property, loss of body member (arm, leg, . . .), loss of body capacity (hearing, eyesight, . . . ), loss of consortium (spouse, parental, child/filial), loss of services, emotional/mental trauma (bystander injury), prenatal injury, exemplary damages, prejudgment interest, attorney's fees, and court costs.
What If I Have No Health Insurance?
Often, a lawyer can issue a letter of protection to a medical facility that guarantees payment to the medical provider out of any automobile or liability insurance proceeds that the lawyer can collect on the case. Not all doctors will accept a letter of protection, there is no guarantee of settlement – the case can go bad and no money received. They must wait for the case to be settled before they get paid. These reasons keep many doctors from accepting letters of protection for treatment. You often must do some calling around to find doctors who are willing to accept a letter of protection.
Personal Injury Areas We Help With Are:
Auto Accident and Injury Cases, Personal Injury Cases, 18 Wheeler & Commercial Vehicle Injury Accident Cases, Motorcycle Accident and Injury Cases, Wrongful Death Cases, Pedestrian Injured by Automobile Cases, Slip and Fall & Premises Cases, Workplace & Constructions Injury Cases, Dog Bite Injury Cases, Bicyclers Hit by Automobile Cases .
Types of Coverage in Automobile Injury Cases:
By Doug Goyen, email@example.com