As a personal injury lawyer, clients often tell me that the insurance company has offered to pay their medical bills to settle their case. This might sound like a good deal, but it usually is not for a few reasons. When an insurance company offers to pay your medical bills, they usually impose a relatively short time limit for when you can receive treatment. In addition to your medical expenses, you are entitled to recover pain and suffering damages, lost wages, and possibly even punitive damages. The company will then ask you to sign a release before they pay the bills. When you sign a release, you agree that you will not seek further compensation from the at-fault person OR the insurance company.
Many people need continuing treatment after an accident. Even if you feel fine a couple days after your initial ER or Urgent Care visit, there’s no guarantee you won’t need treatment for the injuries in the future. If the release you sign limits the time frame for the medical expenses the company will pay, any bills after that time expire will be your responsibility.
Other Types of Damages in a Personal Injury Case
Pain and suffering damages are money paid to you to compensate you for the physical discomfort and inconvenience you suffered as a result of the at-fault person’s conduct. The amount paid for pain and suffering can be multiple times the amount of your medical bills. Punitive damages are money paid to you to punish the at-fault driver for bad conduct. In South Carolina, you can request punitive damages if the at-fault party violated any South Carolina statute. However, punitive damages are most often paid for DUI accidents. Much like pain and suffering damages, punitive damages can be multiple times the amount of your medical bills. If you sign a release in exchange for your medical bills being paid, you will not receive any compensation for your pain and suffering or any punitive damages.
The Collateral Source Rule: What Does It Mean for Your Case?
In South Carolina, we have the “collateral source rule.” The collateral source rule is a legal doctrine that prevents the at-fault party from reducing the amount of damages they owe to an injured party by the amount of compensation the injured party receives from a source independent of the tortfeasor. In simple terms, the person responsible for your injuries does not get a “discount” because you have health insurance, disability insurance, paid time off, or any other number of benefits that you pay for.
The collateral source rule means that you are entitled to the full value of your medical bills. The insurance company will try to get around this by calling your providers directly and negotiating with the provider to lower the bills. That means they pay less, and you pocket nothing.
The collateral source rule also extends to your paid time off (PTO) from work. If you use PTO to receive accident-related medical treatment or due to a medical provider instructing you not to work following the accident you are still entitled to recover lost wages for that time, even if you were paid because of PTO.
But What if My Health Insurance Hasn’t Paid My Medical Expenses?
Health insurance companies may decline to pay medical expenses related to a personal injury claim, instead placing the responsibility to pay on the at-fault person or their insurance. Medical providers may not collect your health insurance information or may not file claims to your health insurance after an accident. Receiving bill after bill while you wait for the at-fault person’s insurance to pay can be an upsetting and stressful experience. There are a few things you can do to try to stop the bills from coming every month.
First, make sure that your providers have submitted your bills to your health insurance. If not, ask them to do so immediately.
Medicare and Medicaid
If you have Medicare or Medicaid, you may have to wait 90 days since the treatment date for the bill to be paid. Medicare and Medicaid are secondary payers, meaning that they are not obligated to pay until the primary payer has paid for the expenses. However, if the primary payer does not pay after 90 days, Medicare and Medicaid will step in.
If you have private health insurance that has declined to pay, contact your health insurance carrier. Ask them to send you their decision in writing, including the provisions of your policy they are relying on for the denial. Ask for a copy of your policy as well.
If health insurance pays bills on your behalf, the health insurance company will have a lien against your settlement. This means you will have to reimburse them from your settlement proceeds. Generally, health insurance pays far less than the billed amount. The lien can often be negotiated with your health insurance company, meaning more money in your pocket.
MedPay and Personal Injury Protection
If your injuries are the result of a motor vehicle accident, you should check your own vehicle policy as well. You may have Medical Payment (MedPay) or Personal Injury Protection (PIP) coverage that can help pay your medical bills.
Settling your case for only payment of your medical bills is letting the insurance company off easy. You deserve to be appropriately compensated for all the damages you have suffered, not just your medical expenses. An experienced personal injury lawyer can assist you and make sure you get a fair resolution to your claim.
