Use of your Health Insurance in a Car Accident Injury Claim

Health Insurance use in Automobile Injury Case: 

Call the Law Office of Doug Goyen if Health Insurance is Used: 

All insurance companies have lawyers helping them.  You need a lawyer to help you, call (972) 599 4100 so we can start working on your claim to protect your rights.  A car accident lawyer from our office will guide your claim through the legal and technical hoops needed to ensure your coverage is not in danger, and that you are fully compensated for your injury.

There is nothing wrong with using your health insurance for a car accident injury claim.  In fact, often, after discussing the facts, I recommend to clients to use their health insurance for their car accident injury medical bills.  Every case is different though, and different circumstances may lead to different advice.  You need a Texas medical care lawyer working on your case to advise you if the use of your health insurance will lead to a better or worse result in your particular situation. 

Despite what your health insurance tells you, you are able to use your health insurance when involved in an automobile accident if you need it.  After hiring us, you will need to discuss your case with our Texas medical care lawyer to help you understand the pros and cons, and how to legally present your claims to the different insurance companies for the best result for you.  

Your health insurance will try to collect against your auto insurance claim - and there is not much you can do about it without an attorney representing you for your interests.   You need to arm yourself with a Texas medical care lawyer to help ensure your rights are protected, and ensure that you receive the maximum amount of money you can receive in your case.  You may not know it, but the claims adjuster for the auto insurance will contact your health insurance eventually, and ask them if they have a "subrogation clause" in their policy (a subrogation clause is a collection clause where your health insurer is entitled to receive first money out of your auto insurance claim.  Almost all health insurers have these subrogation/collection clauses).  If you don't have an attorney, this collection clause in your health insurance often leads to the auto insurance sending your entire settlement amount for your injury to your health insurer instead of you.  You need to hire an attorney to protect you and ensure you receive the money you need to get your life back in order. 

Each automobile injury case is different.  In many cases you need to use, and should use your health insurance in a car accident with injuries. There are other times when you might not want to use it.  An experienced car accident lawyer will know when you should or should not use your health insurance.  Our office has been successfully navigating and working claims involving health insurance for over 20 years in Texas. 

You have nothing to lose, and everything to gain in hiring a medical care lawyer in this situation.  You are not charged a fee if there is no way to recover on your claim.  We charge a percentage of what we recover, so no money comes out of your pocket up front, we are paid a percentage of what we recover (typically 1/3 if no lawsuit is involved - call to discuss rates).  We are able to make sure you are collecting from ALL the insurance coverage you are entitled to receive, and also able to make sure that the money you owe for medical bills and the money that your health insurance is trying to collect from your auto insurance is minimized so that more money goes into your pocket.  You will recover more money for yourself with the help of our experienced car accident lawyers.  You will lose money if you try to navigate this by yourself. 

The car accident lawyer assigned to your case will know the different rules and laws relating to your auto insurance claim and how it may affect the value of your claim, and how if may affect your health insurance coverage.   Our car accident attorneys have experience and knowledge relating to how your auto claim can be affected by various types of private health insurance plans, Medicare plans, Medicaid plans, ERISA plans or other workplace sponsored health insurance plans, state government plans - city plans - or other municipal plans, CHAMPUS or TRICARE plans, disability plans, PIP, MedPay, uninsured motorist, other auto insurance plans, and a multitude of various combinations of these and other types of health insurance and how they interact with each other.  We know how to present these claims in a way that will maximize your recovery while ensuring you understand and approve the use of such coverage if needed.  You will be educated by your lawyer about the effects of each decision, so you know how and why each coverage available can be used to maximize the amount of money you are legally able to receive. 

You need to speak with a car accident lawyer who has experience in handling these complex insurance issues.  The mix of health insurance with auto insurance (along with other possible benefits you may be entitled to use) makes your case more complicated than you may realize.  A car accident lawyer who has been down this road thousands of times can help guide you through the maze of choices to help you maximize your recovery, protect your insurance, and ensure you are following the law in doing so.

Common questions regarding medical care and health insurance following an automobile accident with an injury:  

1) Q: Should I hire a car accident attorney if I am using my health insurance? 

A: At minimum you should consult an attorney and likely you will need to hire a car accident lawyer in these situations.  You do not want to compromise your auto claim, nor do you want to compromise your health insurance coverage by not following the law.  You need an experienced medical care attorney who knows how these coverages work and interact with each other, to ensure your claim (or claims) are processed legally and correctly, and done so in a fashion that ensures you do not jeopardize your coverage available or violate the law.

Every case is different.  If you are dealing with multiple insurers (auto insurance, health insurance, Medicare, Medicaid, workers compensation, etc.) the laws and your rights can be very confusing.  It can be easy to compromise your case and violate the law by doing the wrong thing.  If you are dealing with multiple insurers, you need to discuss your case with an experienced attorney.  We give a free initial consultation to see if you have a case, and what can be done about your case to protect you.  The insurance company has lawyers ensuring their rights are protected, you need a car accident lawyer to protect your rights.  Our firm does free initial phone consultations.  You can call us at (972) 599 4100 to review your case.  If you hire our firm, we can ensure you are not risking your insurance coverage or violating any law by taking any incorrect actions.  

2)  Q:  What doctors or other medical providers am I allowed to see for my injury after an auto accident?

A:  If you hire our firm, your car accident attorney will help you get into a medical facility as quickly as possible to ensure you are receiving the treatment you need.  You will not need to wait for the auto insurance to "approve" your doctor you see.  Depending on your circumstances, you may need to see a doctor on a "letter of protection" - a guarantee from our office to the doctors involved that they will be paid once the claim is settled.  Or you may want to use your health insurance and personal doctors that you already know and are involved in your care.  We will discuss your options to determine which is best for you in your circumstances. 

The auto insurer will drag your case out as long as possible to avoid you seeing a doctor at all if possible, even if you are seriously hurt and need to see a doctor now!  Auto insurers will not "approve" any doctors . . . ever.  If you need to see a doctor, our medical care lawyer will get you in to see a doctor as quickly as possible, often immediately.

The insurance company wants to pay nothing if possible, or as little as they can get away with.  The insurer may start out sounding like everything is fine, but Texas courts allow an auto insurer to initially accept liability and then change their mind at a later date if the insurance company says they "discover" new information.  This happens when the insurance company "claims" you somehow gave them new information in some later conversation, or that they reviewed your statement, and now realize they made a mistake earlier.   You car accident lawyer from our office will ensure you have no need to continue speaking to the adjuster directly, and will stop the risk of telling them something they may try to twist into an excuse for changing their mind, and later denying your claim. 

The auto insurance company may make statements that are "suggestive" of their willingness to pay your medical bills - these are not guarantees of anything.  If you ask the auto liability insurer to give you a written guarantee to pay all your medical bills related to your injury from the collision, the typical response is, "We are still investigating, once we are done investigating, we can talk about that".   Which means, no - they will not guarantee anything.  They never will.  You cannot wait on them to approve anything, the auto insurer will not approve anything. 

Our medical care lawyer will help you to see any doctor you need to see for your injury.  You do not need to wait for the automobile insurance company to approve it first.  We will help you get in to see the doctor you need for your injury.

Our car accident lawyer will get you in to see the doctor you need so your auto insurance companies cannot blame your injury on some other cause for waiting too long.  If you wait to long to see a doctor, the auto insurer will say "Something else must have happened in those 3-4 weeks between the time of the accident and the time you went to the doctor.  You must have hurt yourself working around the house, at your work, while working out, or in some other way, and now you are just trying to relate your injury back to this auto accident.  If you were really hurt from this auto accident, you would not have waited 3-4 weeks to seek medical care."  Our legal team will ensure you get the treatment you need to help you recover, and to protect your rights. 

Don't put your trust in an insurance adjuster who's job is to try to pay you as little as they can get away with, including not paying at all if possible.   If you are in this situation, contact a personal injury lawyer to see what can be done to help you. Put your trust us, we have the incentive to ensure you are treated for your injury, and to ensure you receive the maximum amount your are entitled to receive. 

3)  Q:  Who will pay my medical bills after a car accident?

A:  We will get the insurance companies involved to pay the maximum amount you are entitled to receive.  If you have health insurance, auto insurance, and the other driver has auto liability insurance, you may have several avenues available to get your bills paid.  The problem is that if you use these coverages in the wrong order, you risk not being able to use one coverage or the other.  You will need to present the bills in the correct order to ensure you legally maximize your coverage available.  None of the insurance companies involved want to pay anything if they can get away with it, so they will not give you the information you need to properly present your bills and case in the correct order.  In fact, because their jobs are to avoid paying as much as possible, they will often mislead you into presenting the claim in an order that allows them to deny payment. 

4)  Q:  What if I do not have health insurance?  How can I afford to be seen by a doctor?

A:  Letter of Protection:  If you do not have health insurance personal injury lawyers keep lists of doctors in your area that accept "letters of protection" to see you.  This gives you the opportunity to see a doctor to verify the extent of your injury, and obtain treatment you need for your injury if you do not have health insurance available.   

5)  Q:  What is a letter of protection?    

A:  A letter of protection is a letter from an attorney's office to a medical facility that guarantees that medical facility will be paid out of any automobile insurance proceeds from the automobile accident.   Automobile insurance does not pay bills the same way that health insurers do.  They do not pay bills as they receive them.  Auto insurance companies wait until you are completely done treating then make a "lump sum" offer.  Without an attorney, they may not offer enough to pay for everything.

6)  Q:  What doctors can I see on a letter of protection?

A:  Many different types of doctors see patients on letters of protection.  There are orthopedics, chiropractors, physical therapists, neurologists, surgeons, general practitioners, who will take patients on letters of protection.

    Unfortunately, not all doctors or medical providers will accept a letter of protection.  If you are in this situation, you need an experienced personal injury lawyer who has a network of doctors who do accept letters of protection in order to obtain the treatment you need. 

7)  Q:  Why won't my personal doctor see me for an injury caused by an automobile accident?

A:  Many doctors don't want to see patients for auto accident injuries, or workers compensation injuries.  You will often see signs in the lobby of these doctors offices saying that they don't see patients for workers comp or auto injury cases. 

Typically, the reason they don't want to see patients for automobile accident or workers compensation injuries is that these can be "disputed" claims.  This means that there is a possibility of litigation at some point.  Doctors do not like to be called to court to testify for automobile cases.  They prefer to stay in their office seeing their patients (that is how they keep their doors open).  Most doctors do not like going to trial to testify about one of their patient's cases . . . they prefer treating patients. 

8)  Q:  Will my health insurance pay for my medical bills from an injury caused by a car accident?

A:  Your attorney can help force all insurance companies to cover the portion they are obliged to pay.  Yes, your health insurance should pay for any treatment covered by the plan, but you likely need an attorney to help.

One of the most common misconceptions is that you cannot use your health insurance for an auto accident injury.  This is not true.  If you have health insurance, you should give this health insurance information to the hospital, the ambulance, the doctors, and anyone else who treats you for your injury.  

Your health insurance cannot deny covering the claim.  There are several reasons your health insurance may not deny coverage because you "might" be able to get the auto liability insurance to pay.  

You may feel confident that the other driver's liability insurance will pay, but despite how confident you are, you may be wrong.  Many issues can pop up that cause the auto liability insurance to decide they will not pay.  Remember, this is the adjuster's job, to look for coverage problems, so they can avoid paying if there is a coverage or liability issue.  They will continue searching for these issues, even after they allegedly "accept liability".  They are allowed to change their mind in Texas, and later state that the earlier payments when they thought they should be paying the claim were made in error.

Due to the uncertainty of relying on another person's automobile liability insurance, you really have no choice but to use your health insurance up front.  Your health insurance will have a clause in the policy allowing them to collect against the auto insurance in case the auto insurance does eventually pay the entire claim, but you do not want to take that risk with your financial future.

You need to hire an experienced personal injury lawyer to make sure you present these claims in the correct order, and do so in a way that ensures you are not harmed financially by saying or doing the wrong thing when presenting your claim(s). 

9)  Q:  Should I have my health insurance pay?

A:  There are several reasons you should have your health insurer pay rather than wait on the auto insurance to pay. I'll list some of the more common reasons below: 

        1.  Possible Liability Issues - Changed Story:  First, when you go to the emergency room, you might think the other person's insurance is going to pay eventually.  The problem is that the other driver could change their story to their insurance company.  They may say one thing at the scene of the accident, to you and to the police, and then later when they speak to their insurance company they say that YOU caused the accident, and that the police never asked them for their side of the story, and then they come up with a "witness" in their favor.  This happens all the time - don't think it cannot happen to you.  Get your bills taken care of by your health insurance to protect yourself financially.

        2.  Coverage Issues with other driver's Auto Insurance - Unpaid Premium:  Another reason is that you don't know if the other driver paid his premium that month.  He might have his insurance card that says he has auto insurance, but what if he forgot to make his payment, or his check he mailed in bounced, and 2-3 weeks from now the insurance company says "oh, we just realized, our insured didn't make his payment in time.  We won't be paying for anything else on this claim . . . Denied due to no coverage". 

        3.  Coverage Issues with other driver's Auto Insurance - Violation of Insurance Contract - Wrong vehicle, wrong driver, no permissive use, excluded driver, etc:  Other reasons can cause the insurance to be invalid.  If the other driver is driving a vehicle that is not on the policy - there might not be coverage.  If he let his drivers license lapse, there might not be coverage.  If he lied on his application to get his auto insurance, his auto insurance company might try to get out of coverage.  If he was listed as an "excluded driver" on the policy, there might not be coverage.  If he was living in the house of the insured, but was not listed as a driver at the time of the collision, there might not be coverage. 

        4.  Failure to Report to Insurance Company:  When the other driver fails to report the claim to his insurance company, his insurer may try to deny coverage. Some people don't want to deal with their insurance company, so they put off calling them.  Believe it or not, some don't know that they are required to contact their insurer after an accident, so they never do.  Maybe they don't speak English, and don't know the requirement.  Maybe they are older, and confused about responsibilities of reporting the accident to the insurance company.  Whatever the reason, if they don't cooperate with the insurance company the insurer can use this as "non-cooperation" and use this as an excuse to terminate the insurance contract with regard to this claim.  If this happens, then there is no insurance.

        5.  Amount of Coverage:  You have no idea at the start of your case whether the auto insurance is adequate to pay for the treatment you need (the auto insurance may have low limits - not adequate to cover everyone's medical bills if there are multiple people involved, or if your injury develops into one where surgery or some other expensive type of treatment is needed, the auto liability insurance might not be enough to pay for this);

        6.  You unknowingly say something the insurance company uses against you:  You may accidentally say something to the auto liability insurance company that sounds like you were partially or completely at fault.  Often auto insurance adjusters will try to "lead you" with questions designed to get you to say something that they can use to say "Aha! You admitted that you did _____, which means you were actually the one at fault - or at least partially at fault."  If this happens, they will not be paying for your bills. 

        7.  Lump Sum Settlement:  Finally, even if the auto insurance company has accepted liability, and there is coverage - they are not going to pay your bills as they come in.  They wait until you are done treating for your injury, and then once you have completed your treatment, they will want to make a lump sum settlement with you for the entire personal injury claim (for EVERYTHING related to your injury claim) - all to be paid out of whatever amount they offer.  So if you are still needing treatment, or end up needing surgery for a torn ligament, it might be months before you can actually settle the claim. 

        The hospital bill collectors are not going to wait for you to settle your personal injury claim.  They will be calling, pressuring you for payment, and reporting you to the credit bureaus for non-payment of medical bills . . . all while you are waiting to be fully healed so that you can attempt to settle your personal injury claim with the auto insurance company.  Most people don't want their credit ruined from outstanding medical bills - get them paid by the health insurance, and then the health insurance can be reimbursed out of the auto insurance settlement once the case is ready to settle. 

        Just because you see a valid insurance card does not mean there will be coverage for your injury claim.  The auto insurance company is constantly searching for any reason they can find to not pay the claim.  If they find one, they will use it. 

        Turn your claims for medical (especially the hospital, ambulance, and ER doctor bills) in to your health insurance for payment, to ensure you do not get stuck with the bills personally. 

10)  Q:  Why should MY health insurance be forced to pay when the other guy is at fault?

A:  You want to protect yourself financially.  If a problem pops up with the other person's auto insurance - due to coverage issues, liability issues, a dispute about whether your treatment was necessary for your injury, or a dispute about whether your injury was preexisting or not, or any other problems with the other person's insurance - and it turns out you cannot legally force them to pay, you will have needed to use your health insurance anyway.  If you delay presenting your claims to your health insurance beyond a certain period of time, many health policies will not cover those bills.  In the situation where you have relied on the other driver's liability insurance, where you decided not to use your health insurance.  Several weeks or even months go by, and the auto insurer decides they will not cover your claim, or will not cover the entire claim, then you will be left personally owing those medical bills.  Because the auto liability insurance decided to deny or partially deny for some reason, and you decided not to present the bills to your health insurer so they will not cover the bills due to the delay in presenting those bills.  Now you owe the bills.

Do not put yourself in that situation.  Use your health insurance up front.  Hire an attorney to ensure everything is presented properly, information given to all insurers is done so correctly, and you are able to ensure you have used the insurance coverage available in a proper way to maximize any coverage you may have.

Your health insurance will get their money back if the auto insurance turns out to be valid, and they accept full liability.  This can sometimes take time in certain situations, but eventually, the health insurance gets their money back.  So they do not end up losing anything, they get their money back if liability is proven, and if there is coverage.  If you cannot prove liability, OR if there is not coverage, then you have then saved yourself from having a huge hospital, ambulance, ER doctor, and ER radiology bill outstanding against you personally.  (If you don't turn your claim in to your health insurance within a certain time, many health insurers will not pay the claim - so don't wait, turn it in now - they will get their money back if there is coverage and liability against the other side). 

11)  Q:  I have a high deductible and copays.  What if I don't want to use my health insurance due to those reasons?

A:  I still advise using it.  Your health insurance will "adjust" the hospital bills for you.  Meaning that typically, the hospital bills will often be cut in half or more due to the "contractual rate" your health insurer gets from any medical providers that use your health insurance.

Your bills from the hospital that you are supposed to pay towards your deductible will go towards your yearly deductible - so this actually helps you in case something else comes up later in the year - you will have already met your deductible due to this claim.  Part of your attorney's job will be to advise you of the settlement amounts, and discuss your case with you so that you and your attorney can ensure that your settlement covers your money for your deductible, plus the money for the health insurance, plus anything else you are owed due to your injury. 

You need an experienced personal injury attorney to ensure you present your claims correctly.  It may seems simple at first, but small missteps can ruin your ability to collect the money needed for your claim.

Contact the Law Office of Doug Goyen at (972) 599 4100 for a free initial consultation regarding your case, and how we can help you.  Or Email at douggoyen@goyenlaw.com
 
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