Who Pays My Medical Bills?

There are a number of options available to deal with your medical bills while you are waiting to resolve your personal injury claim. Every case is different, and it is important to take an exhaustive look at all possible options.

Options for paying your immediate medical bills include:

  1. PIP Coverage
  2. Workers’ Comp
  3. Health Insurance
  4. Coverage Provided by the At-Fault Party
  5. Government Programs
  6. Open Accounts with Providers
  7. Crime Victim Compensation Programs

1. PIP Coverage

Oregon state law requires your own auto insurance to provide minimum benefits of up to $15,000 in bills for up to two years. This is called personal injury protection or “PIP” and is a no-fault benefit of your policy. Your insurance company will seek reimbursement of the benefits it pays from the insurance company for the other driver, if he or she is found at fault.

If you are a pedestrian or cyclist injured by a motor vehicle, you are still entitled to PIP benefits under your own auto insurance policy. If you don’t have an auto policy or exhaust PIP benefits available under your own auto policy, you are entitled to PIP benefits from the insurer for the driver of the vehicle involved in the accident. The latter is called secondary PIP coverage; before you are entitled to secondary PIP benefits you must first exhaust any available primary PIP benefits and any available health insurance benefits.

To summarize, if you are an injured pedestrian or cyclist, the order of benefits is: primary PIP (your auto policy), health insurance (your policy), and secondary PIP (involved driver’s policy).

PIP coverage is provided on a no-fault basis. In other words, you are entitled to coverage even if you were at fault.

2. Workers’ Comp

If you’ve been hurt on the job, you may be entitled to workers compensation benefits. PIP may cover what workers’ comp doesn’t cover.

3. Health Insurance

PIP coverage is usually primary. If you don’t have PIP coverage or exhaust the benefits that are available, your own health insurance, if any, typically is the next source of payment for medical bills. Health insurers have strict reimbursement requirements that attach to any personal injury settlement or award. Health insurers also may restrict or exclude future care for injuries. It is critical that the interests of any health insurers that paid injury-related benefits are addressed and resolved with your personal injury claim. This area of the law is complex and evolving.

4. Coverage Provided by the At-Fault Party

You may be entitled to no-fault insurance coverage purchased by the at-fault party. There are two types of coverages that may be available:

  1. The at-fault driver’s PIP if you are a pedestrian or cyclist injured by a motor vehicle (as noted above); or
  2. Medical payments coverage or “med pay.” If you have been injured on property owned by another person, such as a commercial business or a private home, med pay benefits may be available. Unfortunately, the policy limits are often relatively low (around $5,000).

5. Government Programs

If none of the above options are available, then federal and state medical benefit programs like Medicare and Medicaid may provide coverage.

Eligibility for, and availability of, government benefits is a complex topic beyond the scope of this FAQ.

6. Open Accounts with Providers

If you don’t have access to any source of medical benefits to pay your bills while your personal injury claim is pending, some medical providers will agree to hold your account. That means the provider will not send your bill to collections, provided you agree to pay the provider once your claim is resolved.

The willingness of medical providers to hold your account varies greatly from provider to provider. If a provider agrees, they will typically request a “letter of protection” from your attorney. A letter of protection generally says that in the event of a settlement or award, you agree to pay the provider first, before you receive any compensation.

7. Crime Victims’ Compensation Programs

Many states, including Oregon and Washington, have compensation available for crime victims. In Oregon, compensation is available for victims of an “intentional, knowing, reckless or criminally negligent act that results in injury or death of another person * * *.” Compensation is not available in the event of a non-criminal accidental injury or death. Benefits may include expenses related to medical, hospital, mental health counseling, loss of earnings, and rehabilitation services. Compensation for pain and suffering is not available. Crime Victims’ Compensation is a payer of last resort; in other words, you must first exhaust all other available benefits. For additional information contact:

Crime Victims’ Compensation Program
Department of Justice
1162 Court St. NE
Salem, Oregon 97301-4096
Telephone (503) 378-5348
http://www.doj.state.or.us/victims/compensation.shtml

Reimbursement of Benefits—a Big Surprise

Many people do not realize that when a health insurer or other entity (including PIP, workers’ comp or government programs) pays their medical bills these entities almost always have a right to get paid back from any settlement or award in your case. The right to reimbursement comes as a big surprise to many people.

Why should you care about reimbursement? If you resolve your personal injury case without addressing the reimbursement rights of health insurers and anyone else that has paid benefits for injury-related care, you risk getting sued to recover the benefits paid. If that happens, you could lose your entire settlement or be prohibited from receiving future care for your injuries.

How a Personal Injury Attorney Can Help

Finding ways to pay your bills (and making sure the correct sources pay the correct bills) can be difficult. Important tasks that an experienced personal injury lawyer undertakes are:

  • locating and establishing sources of payment for your medical bills;
  • keeping track of all your bills and any outstanding balances and, when possible, stopping your bills from going to collections while your case is pending;
  • ensuring that the correct and most advantageous source is paying the bills; and
  • negotiating reimbursement and future care with your health insurer and any other entity that has provided medical benefits on your behalf.
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Rob Kline

Rob has extensive experience helping injured people find ways to pay their medical bills while their case is pending. Call now for a free, confidential case evaluation.

(503) 224-6246