Who will pay my medical bills?
Medical bills are usually the costliest expense associated with a personal injury case. These bills are incurred during the initial emergency medical response and, if long-term or lifetime medical care is required, remain an ongoing concern for the injured party and their family.
Automobile Accidents:
If you are involved in a motor vehicle accident in in New York and/or New Jersey your medical bills are covered under “no-fault” insurance – also known as Personal Injury Protection (PIP). While there are variations as to the actual insurance company responsible for the bills, the general rule is that your medical bills are paid by the insurance company of the car you were occupying regardless of fault (hence the term “no-fault”). The minimum amount of benefits for this type of coverage in New York is $50,000.00. New Jersey affords its beneficiaries at least $250,000.00 in coverage.
Pedestrians in New York are covered by the vehicle that struck them while pedestrians in New Jersey are covered by their own motor vehicle insurance and/or those of a family member with whom they reside.
MVAIC and NJ PLIGA are the last resort for PIP benefits for New York and New Jersey accidents, respectively. MVAIC (Motor Vehicle Accident Indemnification Corporation) will cover your medical bills in situations where the car you were traveling in did not have insurance, if you were a pedestrian struck by an uninsured vehicle or were the victim of a hit-and-run accidents.
NJ PLIGA (New Jersey Property – Liability Insurance Guaranty Association) will also cover your medical bills if you were traveling in an uninsured vehicle that you did not own or if you are a pedestrian without car insurance or a household policy.
Work related motor vehicle accidents are covered by Worker’s Compensation. In situations where you are driving during the course of your employment, Worker’s Compensation will be the primary source of medical benefits and will essentially step into the shoes of the “no-fault” PIP carrier.
Workplace Accidents:
Whether you were injured in a motor vehicle accident, construction accident or slip and fall, your medical bills may be covered by any applicable Worker’s Compensation insurance if you were hurt while performing your work duties.
Any medical bills incurred as a result of a workplace accident will require that a claim be made with the Worker’s Compensation Board and, as with all such claims, it should be handled by an attorney who will fight to make sure all your medical bills are covered.
Premises liability (slip/trip and fall or falling objects):
Most of the time, the injured person will be required to pay their medical bills out of pocket or through their health insurance. In some instances, the owner of the premises will carry “med-pay” coverage, which will provide a pre-determined amount of medical bills based on the insurance policy of the insured owner.
Injuries resulting from Medical Malpractice and/or Nursing Home negligence:
Health insurance – whether private or through public assistance – will be the primary source for the payment of your medical bills.
How long will I continue to receive medical benefits?
Medical benefits by way of PIP or Worker’s Compensation will continue until the insurance company deems the medical treatment to be unnecessary. To make this determination, insurance companies will hire doctors to perform a medical examination on you. My experience, over the course of handling many of these cases, is that invariably these examinations yield reports stating that the claimant/patient is no longer in need of medical treatment and that all benefits should be terminated within a certain period of time. An important part of my legal practice with accident victims is to fight back and make the case for extended care whenever, in fact, it is medically recommended or necessary. The cost saving mandate of large insurance companies all too often interferes with sound medical judgment. I am committed to fight for my clients to make sure benefits remain open as long as necessary and not just when these doctors rubber stamp an examination form.
Do I have to pay the insurance company back for the money they spent on my medical treatment?
Yes and No as the answer to this question is very fact specific depending on who has paid the medical bills. Generally, the first $50,000 ($250,000 in NJ) of no-fault insurance payments are unrecoverable against an injured person.
Moreover, recent changes in New York law have enabled victims of negligence keep more of their financial recovery. Previously, many private insurance companies were entitled to a “lien” which was basically an “I owe you” on the monies recovered in a claim/lawsuit. Since the signing of an amendment to the anti-subrogation statute in 2013, most insurance companies are not permitted to hold their hand out seeking reimbursement from an injured party at the end of a case.
As with anything in the law, though, there are exceptions to this anti-subrogation law in that the statutory rights of reimbursement are protected for benefits paid by Medicare, Medicaid, Worker’s Compensation, ERISA protected insurance plans and optional and additional no-fault benefits in auto injury claims.
Clearly, these intricacies make it crucial to retain a knowledgeable and aggressive attorney who will fight to keep as much money in your pocket as permitted under the law.
Does the person or entity that caused my injuries have to pay my medical bills?
The short answer is No – until there is a judgment entered against that person as a tortfeasor, which means there has been a legal determination that their negligence was the cause of your injury.
While it is true that, certain insurance policies provide for immediate coverage for medical bills in cases where you are injured on someone’s property, these benefits are not guaranteed for any period of time and are subject to the discretion of the insurance company and the doctors of their choosing.
Given the ever-rising cost of medical care, past and future medical bills can be one of the largest financial losses sustained in an injury case. In addition, these losses usually continue well after a case has been resolved. A victim of negligence has one chance to get full compensation. Therefore, you need an attorney that will fight all the way to trial, if need be, to force the negligent party to pay not only for the expenses to date but those reasonably anticipated to be incurred in the course of future care.
