The biggest concern a person will likely have to deal with after sustaining an injury in a motor vehicle accident are medical bills. Just a routine examination in a hospital emergency room following an accident can cost several thousand dollars. If you need to undergo any additional treatment the bills can be astronomical.
New York is a no-fault state. Therefore, you will be qualified immediately following your accident for no-fault benefits. Further, since New York is a no-fault state your car insurance coverage will be your primary source of insurance coverage for your medical treatment. This means that all medical bills must be submitted to the no-fault carrier for payment. Any bills submitted to your private health insurance will be denied if no-fault insurance is available to you.
The only exception to this rule is if you are in a motor vehicle accident while at work. For example, if you are making a delivery for your job and are rear-ended. In a scenario where you are injured during the course of your employment, workers compensation insurance will become the primary insurance policy and no-fault will be secondary. However, if you are on your way to work or on your way home from work and off the clock, no-fault will still be your primary insurance.
No-fault insurance will cover all of your medical bills up to $50,000 or if you are terminated from coverage, as per an Independent Medical Exam. Therefore, sometimes, you may need medical treatment but no longer have no-fault benefits to pay for that treatment. In this situation, you will be left with a few options. First, you can submit your medical bills to your health insurance carrier. The carrier will likely want to see a denial from no-fault before agreeing to pay for medical treatment.
If you are a Medicaid recipient you can submit your medical bills to that entity once no-fault is denied. There are two issues I see arise with this situation. First, not all doctors accept Medicaid. Therefore, you might need to switch healthcare providers. While this is inconvenient, it is better than the alternative of receiving no treatment. The second issue that arises is that unlike no-fault, Medicaid must be reimbursed for medical payments should you receive a settlement.
Medicare works similar to Medicaid in that it will cover medical expenses once your no-fault benefits are denied. Also, like Medicaid, if a settlement is reached, Medicare will be entitled to reimbursement for its expenditures.
Another option to get medical bills paid is to approach the healthcare provider about accepting a lien on your personal injury settlement. I often can get a healthcare provider to continue treating a client while their case is proceeding and await settlement before receiving payment. Obviously, this will not be an option if you are not pursuing a bodily injury settlement. It is also likely a last resort as it is always better to get an insurance company to pay for the treatment up front because they are only entitled to repayment if you receive a settlement. On the other hand, a doctor’s lien will usually stipulate that you are responsible for the bill should there be no settlement.
The last option for getting medical bills paid is through a personal injury lawsuit. If another person causes your injuries, they are responsible for any economic damages associated with that injury, including medical bills not covered by no-fault. There is a caveat to this rule. It must be proven that you have suffered a “serious injury” from the motor vehicle accident before the responsible party is required to pay for your economic losses. “Serious injury” is defined by a law.
Finally, should you run into any problems with receiving medical payments, it is always a good idea to speak with an attorney. They can often solve the problem and get you reimbursed for your losses.