What is a Medical Payments Claim in a Car Accident?

If an individual was injured in a car accident and seeks to recover payment for medical expenses, he or she may seek to file a medical payment claim.  The medical payment claim may be filed with one’s own insurance company or the other driver’s insurance company as a third party claim.

What is Included in a Medical Payments Claim?

Typically, a medical payment claim seeks to obtain reimbursement for or direct payment of any of the following:

• hospital stay bills
• surgical bills
• therapy bills
• prescription medication bills
• ongoing and/or future medical care expenses

Insurance Claims Medical Payment Coverage

Medical payment claims coverage via automobile insurance policies typically applies to the medical expenses for the driver and the driver’s passengers when the driver is in an accident.  The coverage usually applies when the driver seeks to obtain recovery from their own insurance company instead of looking to another entity for recovery.

Restrictions on Recovery from Third Parties for Medical Payments Claims

Some states have insurance laws which restrict one’s ability to recover medical payment claims against a third party.  These insurance laws have been established to prevent duplicate coverage and to prevent individuals from filing third party insurance claims for car accident injuries which are eligible for coverage by one’s own automobile insurance policy.  However, these laws generally allow an individual to seek recovery from a third party for any medical payment amount which is not covered by one’s own automobile insurance policy.

Limitations on Coverage for Medical Payments Claims

Most automobile insurance policies have a limitation on the coverage for medical payments claims.  Presently, a very basic automobile policy may include a limit of $5,000.00 for medical payments claims.  However, every policy varies with respect to this limitation, so it is important to review one’s policy in order to obtain the specific limitation. 

Timing of Payment for a Medical Claim

Most automobile insurance policies include a provision whereby the holder of the policy must incur a certain amount of expenses before the insurance policy will provide for the payment of a medical claim.  This amount varies by each individual policy; therefore, it is important to review and understand the terms of one’s automobile policy.

When to Talk to a Lawyer

If one has been injured in an automobile accident and has medical bills, one may seek to retain the services of an experienced attorney.  An experienced attorney can evaluate one’s case and can advise as to the appropriate course of action.  Moreover, an attorney can review an insurance policy and determine what a victim is entitled to receive.  Furthermore, an attorney can make sure that a victim receives the compensation he or she deserves, and can institute a lawsuit to do so, if necessary.