Injury Claims: Who Pays?

For those who suffer injuries in a car accident, much confusion exists as to who is financially responsible for the injured party’s medical expenses. The answer to this question is not clear cut and will depend heavily on the insurance laws of the state in which the accident occurs. How medical bills are paid after an accident will vary based on whether your state has a fault-based auto insurance system. In this post, we’ll discuss more about who pays personal injury claims and give you instructions on what to do if you are injured in an auto accident.

No-Fault vs. Tort Liability States

A tort liability, or fault-based, auto insurance system requires insurance companies to make payments commensurate with each party’s level of fault. In a fault-based system, you can sue the other party for pain and suffering and uncompensated financial damages. Because of the long court battles and many failings of the fault-based system, about 22 states have adopted some form of a no-fault insurance system. With a no-fault system, the driver who is not at fault does not have to prove his/her innocence before receiving compensation from his/her insurance company. However, in no-fault states, the good driver does not have the right to sue the at-fault party for emotional distress, inconvenience, or pain and suffering.

If You’re Injured

If you are injured in an auto accident, you are the one who is financially responsible initially. Once your treatments are complete, who pays for your medical expenses will depend on who was at fault. Here is what you should do if you are injured in an auto accident:

1. Get emergency medical treatment if needed.
2. Contact your insurance company. If you don’t think you were at fault in the accident, contact the other party’s insurer ASAP to initiate the claims process. Keep in mind that the other driver’s insurer will not pay your medical bills piecemeal; rather, you will receive one final settlement after all of your expenses are known and the accident investigation is complete. Keep records of all of your accident-related medical expenses.
3. Set up follow-up care (non-emergency treatment). Make sure you are keeping a record to document your pain and suffering in case you have to sue the other party for compensation.
4. You will be billed for your medical expenses.
5. Pay your bills. If you have medical payments coverage or personal injury protection on your auto policy, submit your medical expenses to your car insurance company. If not, submit the bills for covered treatments to your health insurer.
6. Determine fault. If the accident was your fault, you are done with the claims process once you submit your bills to your insurer (health or auto). However, if the accident was the other driver’s fault, get in touch with the driver’s insurer to discuss your final settlement. Remember that lawyers, medical providers, and health insurers might be entitled to part or all of your settlement. If the other party is uninsured, you will need to contact your insurance company to activate your uninsured/underinsured motorist coverage and discuss your settlement.