How are Medical Expenses dealt with in the Settlement of an Auto Accident Injury?

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Jeffrey Johnson is a legal writer with a focus on personal injury. He has worked on personal injury and sovereign immunity litigation in addition to experience in family, estate, and criminal law. He earned a J.D. from the University of Baltimore and has worked in legal offices and non-profits in Maryland, Texas, and North Carolina. He has also earned an MFA in screenwriting from Chapman Univer...

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UPDATED: Jul 15, 2021

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Whether you are presenting an Auto Medical Payments claim to your own insurance company or settling an Auto Bodily Injury claim with someone else’s insurance carrier, you should be aware that none of your medical providers can submit the medical bills on your behalf. Any bill you want paid by a specific insurance company, must be sent directly to that company. Even if claims representatives from two companies are communicating, they can not exchange medical bills.

From the beginning of your injury be absolutely certain to ask every facility that is treating you to provide you with a copy of the bill, and keep a copy or the original of each one, in case one is misplaced at the insurance company or lost in the mail. This applies even to Kaiser Permanente, although they will adjust the bill to reflect all charges before sending you their bill. This may take a very long time.

The insured person and any family members can submit medical bills incurred when occupying a vehicle, struck as a pedestrian or struck by a trailer, to their own insurance company under the Auto Medical Payments coverage. This coverage also applies to persons you give permission to drive your car, and any passengers you allow inside your vehicle. The coverage amount is very nominal usually $1,000 to $5,000 per person.

It is important to be aware that there may be a “reimbursement clause” or “duplicate payment clause” or both which applies, if you collect an Uninsured or Underinsured Motorist Bodily Injury Settlement, or Auto Bodily Injury Settlement for the same bills as those submitted for Auto Medical Payments. Check your policy, this varies. There may also be an “excess provision” which does not allow you to collect from both your health insurance and auto insurance policies. This also varies from one company to the next.

If you are presenting an Auto Bodily Injury Claim or Uninsured or Underinsured Motorist Bodily Injury Claim, you are entitled to reimbursement for your medical bills, any lost wages and “general damages”, which is a multiplier based on the underlying “special damages”. Medical bills, lost wages and any other damages that can be documented are considered “special damages“. “General Damages” are meant to issue monetary remuneration for “pain and suffering” incurred due to the “crash”. Regarding the latter, read “What is Reasonable Pain and Suffering? and “How do Insurance Companies and Juries Assign Values to Pain and Suffering?

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