If you're hurt in an accident that's someone else's fault, you may wonder about paying your medical bills. A personal injury settlement is great—so is a favorable verdict on the very rare occasion when a personal injury lawsuit goes to trial. But those are future outcomes, and they won't help you pay your medical bills now.
The most important thing to know is that, if you get into an accident, you're generally responsible for making sure your medical bills are paid as you incur them, until any underlying insurance claim or lawsuit is resolved. The only exceptions are usually:
When an injury claim is made under the above three kinds of coverages, you can usually submit your medical bills as they come in, and rolling claims can be paid out until the coverage limit is reached. More on all of these kinds of insurance claims later.
But those exceptions aside, even when a person or business is clearly at fault for your accident, the law doesn't usually require them (or their insurer) to pay your medical bills on an ongoing basis.
Strictly speaking, if and when the other person/business is found at fault in court, that's the moment at which they'll be ordered to pay your losses ("damages" in the language of the law). And in a personal injury case, your medical treatment is a big part of those damages. But the defendant doesn't usually have to pay your medical bills as they come in.
Of course, most injury cases settle, often well before trial or even before a lawsuit is filed in court. But the same logic applies: it might take several months or more than a year to reach an acceptable personal injury settlement with the other side, and until there's a resolution, you'll need to make sure your medical bills are paid.
Learn more about damages in a personal injury case and how medical treatment affects the value of an injury claim.
When different kinds of coverage could be used to pay for treatment of your accident injuries (i.e. health insurance, car insurance, Medicare, and so on) it's important to understand the interplay among them. Which policy is "primary," meaning it must be used first to treat your accident injuries? Which policies are "secondary," meaning they can be used to treat your accident injuries only after the primary coverage is used up?
Typically, "medical payments" insurance and similar kinds of coverage (included "personal injury protection" or "PIP" car accident coverage) need to be used first when they apply to an accident. Those are "primary," in other words. Once the claimant has reached the policy limits of that coverage, they can turn to their health insurance as "secondary" coverage.
If you're injured in a car accident, quick payment of your medical bills often depends on whether the accident happened in a "no fault" state. No fault car insurance means that your own automobile insurer will pay some or all of your medical bills if you get into a car accident, (often more promptly than in traditional "fault" states) regardless of who was at fault for the accident, up to the limits of your no-fault coverage.
After your medical bills exceed the state's "no fault" limit, you're responsible for making sure they get paid. If you have health insurance, your health insurer will pay your medical bills. If you are on Medicare or a state run health insurance program through Medicaid, those entities will pay the bills. If you do not have health insurance, Medicare, or Medicaid, then you are responsible for working out payment arrangements with your health care providers.
It's important to note that if your medical bills exceed a certain amount (or your injuries qualify as sufficiently serious) you'll be able to step outside the no-fault system and file a traditional liability claim against the at-fault driver, but this process will almost certainly take a while to resolve, so you'll still need to find a source of payment for incoming medical bills.
Learn more about how no-fault car insurance claims work.
If you get into a car accident in a state that does not follow a no-fault car insurance system, you will generally be responsible for paying your medical bills as they accumulate. However, some drivers in these states have medical payment insurance coverage (known as "med pay" coverage), which will pay the medical bills of anyone covered by the policy up to the "med pay" limit, which is usually less than $10,000.
The same is true of "personal injury protection" (or PIP) car insurance, which operates much the same as no-fault and medpay insurance. Learn more about how PIP coverage works after a car accident.
After your bills exceed the "med pay" or PIP policy limits, you will be responsible for paying them. Again, it's important to understand the interplay between your medpay coverage and your health insurance (which policy is primary and which is secondary).
In a premises liability or slip and fall case, the injured person will generally be responsible for ensuring payment of their medical bills as they come in, unless the property owner's liability insurance policy includes "medical payments" coverage.
A commercial liability insurance policy will usually include some version of "medical payments" coverage. So if you slip and fall in a store and fault is pretty clear, you can probably get your medical bills paid fairly promptly through the store's insurer before the larger case is resolved.
Most homeowners insurance policies also contain a "medical payments" provision, which will provide fairly immediate payment of reasonable medical treatment for anyone injured in an accident on the homeowner's property (after a dog bite or stair accident, for example). Note that this usually applies to visitors and guests only; any "medpay" provision typically excludes the property owner and family members.
If you get hurt in a work-related accident and you make a workers' compensation claim, the workers' compensation insurer will likely pay all of your medical bills pretty quickly as they come in. You do not typically have to pay any bills or deductibles. Further, many states require the workers' compensation insurer to reimburse you for transportation expenses (mileage, tolls, and parking) for travel to and from your medical appointments. Learn more about settling a workers' compensation claim.
If a health insurer, Medicare, or the state agency administering Medicaid benefits pays your medical bills related to your accident, they are entitled to be reimbursed for what they paid your health care providers, if you eventually receive a personal injury settlement or a favorable court verdict against the defendant. Learn more about health care liens in personal injury cases.
If you've been involved in an accident, and you want to understand your options (insurance coverage-wise and beyond), it might make sense to discuss the specifics of your situation with a legal professional.
You can use the tools right on this page to connect with a personal injury lawyer in your area. Answer a few initial questions and you could be eligible for a free case evaluation. Learn more about finding the right personal injury lawyer.