Why the Auto Insurance Company Will Not Pay Your Medical Bills

April 13, 2023

By Thomas McCutcheon

Accident claims are valued and paid based on the severity of the injuries people receive. Those injuries are probably best documented by the treatment that people get for those injuries. Automobile insurance carriers will not pay your medical bills until you are through treatment. If you do not get the treatment that you need because you can’t afford it, they don’t have to pay for it, and your claim is worth less. That is a “twofer” for the at-fault driver’s insurance company.

If and when your claim is settled, part of the settlement will be based on the treatment that you received for the injuries that were related to or caused by the accident.

Your health insurance company may decline to pay for certain treatments. There is not much that you can do about that. Last month in Alabama, a man’s health insurance company would not pay for a surgery that he was told he needed in the emergency room. His health insurance company declined to approve the surgery. He returned to the emergency room, and he was told a second time that he had to have this surgery. Again, his health insurance company refused to approve the surgery. He then died. His widow sued his health insurance company, and the court held that they were protected under a federal law known as ERISA.

ERISA was passed by Congress in 1974 and makes it virtually impossible to sue your health insurance company for failing to authorize treatment that a person needs. When Congress passed it, they exempted themselves. It’s a really bad law in many ways (unless you’re in Congress, and then it doesn’t apply).

Back to the automobile accident cases, most auto insurance policies do carry medical payment coverage that will pay for medical bills associated with a car accident up to the monetary limit that you purchase. Some of these medical payment policies are really helpful, however, we’re seeing more and more people decline medical payment coverage. That is not a good idea at a time when co-pays and deductibles are really expensive. 

Buckle up, drive safely, and as always, your referrals are appreciated!


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