Health Insurance use in Automobile Injury Cases

Health Insurance use in Automobile Injury Cases: 

Each automobile injury case is different.  In many cases you should use your health insurance, but there are some times when you might not want to use it.

You need to speak with an attorney who has experience in handling 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 complicated.  A 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.

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

1) Q: Should I hire a lawyer if I am using my health insurance? 

    A: You should consult an attorney and likely you will need to hire an attorney.  You do not want to compromise your auto claim, nor do you want to compromise your health insurance coverage by not following the proper procedures.  You need an experienced attorney who knows how these coverages work, to ensure your claim (or claims) are processed correctly, and done so in a fashion that ensures you do not jeopardize your coverage available.

    Every case is different.  If you are dealing with multiple insurers (auto insurance, health insurance, Medicare, Medicaid, workers compensation) the rules can be very confusing.  If you are not experienced in dealing with insurers for injury claims, it can be easy to compromise your case by doing the wrong thing.  If you are dealing with multiple insurers, you need to discuss your case with an experienced attorney.  Attorneys who do personal injury cases typically will give a free initial consultation to see if you have a case, and what can be done about it.  Our firm does free initial consultations.  You can call us at (972) 599 4100 to review your case to ensure you are not risking your insurance coverage(s) by taking the incorrect action.  

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

    A:  If you hire an experienced personal injury lawyer, they can help you get into a medical facility as quickly as possible to ensure you are receiving the treatment you need.  You do not need to wait for the liability auto insurer to "approve" your doctor you see.  In fact, the liability auto insurer will not "approve" any doctors . . . ever.  If you need to see a doctor, we can help you if you hire our firm.

    The problem is that with another person's liability insurance - you do not have a contractual relationship with that other insurance.  You do not know if they will treat you fairly when they eventually see your medical bills.  You do not know if they will change their mind about liability, or change their mind about coverage (which they are allowed to do in Texas - Texas courts allow an auto liability insurance company to accept liability and then change its mind later if the insurance company "discovers" new information at a later time or decides later that they interpreted the information they had incorrectly.  Same with coverage, Texas courts allow auto liability insurance companies to tell you there is coverage, but then later change their mind if they discover that there should not have been coverage and they made a "mistake"). 

    If any of those things happen, you may end up with large medical bills that neither the auto insurer nor the health insurer will pay if you listen to the health insurer's advice of not using the health insurance and relying on someone else's automobile liability insurance.  Contact us, we can help you with these insurance "conflicts" and deal with the insurers to make sure you receive the medical care you need. 

    The auto liability 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 they will 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.  Meaning you cannot wait on them to approve anything, they won't approve anything. 

    You are allowed to see any doctor you need to see for your injury, at any time.  You do not need to wait for the automobile insurance company to approve it first.  We can help you get this set up if we are handling your case.

    Auto insurance companies will try to blame your injury on some other cause if you wait too long.  They 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." 

    It does not matter that you have been communicating with the insurance adjuster the whole time, telling them that you are waiting on them to give a liability or coverage decision so they can approve you to go to a doctor.  They will still use those above arguments to try to avoid paying - even if they know it is untrue.  It is the auto insurer's job to use whatever they can to avoid paying whatever they can avoid paying.  Don't put your trust in someone (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.   Don't trust someone who's job is to avoid paying you.  If you are in this situation, contact a personal injury lawyer to see what can be done to help you.

    See a doctor immediately if you feel you need medical attention.  Do not wait on the auto insurance company to make its liability or coverage decision.  You are only hurting yourself if you do - both financially, and possibly physically too if you are denying yourself needed medical attention for your injury. 

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: 

        a.  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.

        b.  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". 

        c.  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. 

        d.  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.

        e.  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);

        f.  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. 

        g.  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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