Who Pays Medical Bills While a California Injury Claim Is Pending?
A bodily-injury liability claim usually does not function like health insurance. The responsible driver’s liability insurer generally does not pay each medical bill as treatment occurs simply because a claim has been opened.
Health insurance may pay first
When available, health insurance can pay accident-related medical expenses subject to the terms of the plan. Copays, deductibles, exclusions, reimbursement rights, and provider-network rules may still apply.
Medical Payments coverage may be available
Some automobile policies include Medical Payments coverage, commonly called MedPay. MedPay is different from bodily-injury liability and UM/UIM coverage. The available amount and reimbursement consequences depend on the policy and circumstances.
Some providers may treat with a lien or deferred-payment arrangement
A medical provider may agree to defer collection and seek payment from a later recovery. That does not mean the treatment is free. The patient may remain financially responsible under the agreement.
Medical damages are not necessarily equal to the sticker price of a bill
California damages law focuses on the reasonable cost of reasonably necessary medical care attributable to the injury. The amount recoverable is not determined solely by the face value of a bill.
Reimbursement claims may affect the settlement
Health plans, Medicare, Medi-Cal, workers’ compensation carriers, medical providers, and others may assert reimbursement or lien rights depending on the circumstances. Those claims should be identified and evaluated before final distribution.
Keep a complete billing file
Preserve provider bills, explanations of benefits, payment histories, lien agreements, insurance correspondence, MedPay records, and collection notices.
Glendale Law Group evaluates medical billing and insurance issues as part of personal-injury claims throughout Southern California. Call (818) 745-0101 for a free consultation.
This article provides general information only and is not legal advice. Reading it does not create an attorney-client relationship. Deadlines and rights depend on the facts, applicable law, and insurance policy language.
