You're driving the speed limit on the freeway, on your way home from work, when a car traveling at a high rate of speed swerves into your lane and sideswipes you. The impact causes you to lose control of your vehicle, and you strike the median wall. Injured but conscious, you look around for the car that hit you, but it is nowhere in sight. You're the victim of a textbook hit and run car accident.
Other drivers stop to render aid, and the police arrive minutes later. No one seems to have a good description of the car that struck you; all you know is that it looked like an older model SUV that was black or navy blue. You are in a lot of pain. An ambulance takes you to the hospital, where you are treated for your injuries. Once you are discharged, you follow up with the police and your car insurance company. They advise you that neither the offending driver nor the vehicle have been located, and that your own car insurance will be the sole source of any recovery for your losses caused by the hit and run accident.
So, the question of "who pays" in a hit and run accident is usually answered by referring to the terms of your car insurance policy, and the insurance rules in place in your state.
If you live in a no-fault car insurance state, your own car insurance policy (typically it's called "personal injury protection" or "PIP" coverage) will provide compensation for your medical expenses, lost wages, and cost of replacement services (to assist you with your daily chores and activities), depending on the rules in place in your state, and the details of your coverage. All of these benefits will have limits; in some cases the limits will be set by you, depending on the amount of insurance you choose to purchase, and in other instances the limits will be in line with what's required under your state's law.
While no-fault/PIP coverage will compensate you for your economic losses, regardless of who caused the accident, no-fault/PIP won't provide compensation for your "pain and suffering" and other non-economic losses caused by the car accident.
If you have collision coverage (which applies to damage to your vehicle), you'll be able to make a claim for vehicle damage caused by the hit and run driver, but you will also have to pay any deductible on your collision coverage (the deductible might otherwise be recoverable from the at-fault driver, but obviously not in a hit-and-run case). And remember that collision coverage will have no bearing on your injuries; it only applies to vehicle damage.
If the driver and owner of the vehicle that struck you cannot be found, uninsured motorist coverage may your best (and only) source of recovery for your losses. Instead of bringing a claim against the responsible driver (which isn't possible after a hit-and-run), your claim will be against your own insurance company. Your insurance company's obligation will be limited by the amount of uninsured motorist coverage you have purchased, and you may ultimately have to bring a lawsuit against your insurer if you cannot reach a settlement of your claim. But you're typically able to recover for your medical bills, lost wages, and pain and suffering, up to the limits of your UIM coverage, and in states where uninsured motorist property damage is available, you can get reimbursed for damage to your vehicle too.
Especially if you do not live in a no-fault insurance state, you might have purchased car insurance solely to protect you against a claim made by someone else who was injured due to your negligence -- liability insurance, in other words. But liability insurance won't cover your expenses and losses caused by someone else's negligent conduct.
If you only have liability coverage, your car insurance policy won't help you when it comes to injuries and vehicle damage caused by a hit and run driver. In this situation, your car accident injuries would hopefully be covered under your health insurance.
Learn more about how insurance affects a car accident case.