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Paying Medical Bills Post-Accident: A Roadmap through VA, MD and DC



In the first two posts of this series, we reviewed common terms and sources of first- and third-party auto insurance coverage for paying medical bills, as well as the most common forms of health insurance available to accident victims for seeking treatment. We now share with readers a Roadmap of tips for paying accident-related medical bills around the beltway – first in Virginia, then Maryland and finally D.C.

First Stop: Virginia

 

  • TIP: Review your health insurance plan. Any provider that is in-network with your policy has an obligation to bill the health insurance company for the cost of your treatment. (See VA Code 8.01-27.5). Feel free to use your health insurance benefits, but keep in mind you will have to pay your co-pays and be subject to your deductibles. Health insurance is especially helpful with hospital providers, for diagnostic testing, and for specialists who will only see patients with health insurance.
  • TIP: Review the auto policy covering the vehicle that you were in at the time of the accident “Host Vehicle Coverage.” If the vehicle’s owner has purchased any Medical Payment (MedPay) coverage, that benefit is available to each person that was injured in the accident. The amount shown on the policy is multiplied by the number of vehicles on the policy, up to 4 vehicles.
  • For example, if the policy has $2,000 in MedPay coverage and there are 4 cars on the policy, each occupant of the vehicle qualifies for $8,000 in MedPay coverage ($2,000 x 4 vehicles = $8,000). MedPay pays 100% of incurred medical bills up to that limit (and subject to any valid audit of the bill). If a bill is already paid by health insurance, then MedPay pays an amount equal to the health insurance payment, plus any out-of-pocket amounts associated with co-pays and deductibles.
  • TIP: Review the auto policy for the driver of the vehicle you were in at the time of the accident, your own auto policy, and the policies of your own household resident relatives (“Household Vehicle Coverage”). If any of these other policies have MedPay coverage than the Host Vehicle Coverage, you may qualify for additional MedPay benefits.
  • TIP: Once you are done with all of your medical treatment and know the full extent of your damages, you can submit a claim to the tortfeasor’s auto insurance company. They will evaluate your claim and pay out a lump sum settlement for your economic damages, pain and suffering. We recommend that you do not settle your claim without consulting with an attorney who practices in the area of personal injury law because once your claim is settled, you will be asked to sign a release forfeiting all rights to any future claims. In Virginia there is a two-year statute of limitations to resolve a personal injury claim or file a case in court.

 

MYTH: “If I use the MedPay coverage from my policy, even though the accident was not my fault, my insurance rates go up.”

 

FACT: MedPay is a no-fault benefit, which means you have paid to have it on your policy and it is intended to protect you and cover your medical bills regardless of who is at fault in an accident.

 

MYTH: “There’s no reason to use my health insurance and MedPay if the accident was not my fault.”

 

FACT: Virginia allows and promotes the use of all of your sources of coverage. Virginia is also an anti-subrogation state, which means, as a general rule, health insurance does not have to be reimbursed when used to pay for accident-related medical bills. The exception to the rule is that, as discussed above, Medicare and Medicaid always have to be reimbursed; and private health insurance (both employer-based and consumer-based plans) have to be reimbursed when they are fully self-funded. Whether a plan is self-funded can be confirmed by thoroughly reviewing the master plan documents of your health insurance contract to confirm the funding provisions. If the health plan is funded by the premiums paid by the covered members, then the plan is considered fully self-funded. If the plan is partially funded by insurance funds, than the plan is not fully self-funded and has no subrogation rights in Virginia. However, plans that are governed under a federal law called ERISA (29 U.S.C. § 1144(a)) are not subject to Virginia’s anti-subrogation law and do have the right to be reimbursed.

Next Stop: Maryland

 

  • TIP: Review the auto policy covering the vehicle you were in at the time of the accident “Host Vehicle Coverage,” and determine if they have PIP coverage. Since this is an opt-out benefit, every auto policy in Maryland will have the minimum PIP coverage ($2,500) unless the policyholder signed a waiver opting out of that coverage. We strongly recommend against waiving PIP coverage and encourage those who have to contact their auto insurance agents immediately, in writing, asking that full PIP coverage be restored to their policies.
  • TIP: Review the auto policy for the driver of the vehicle you were in at the time of the accident, your own auto policy, and the policies of your own household resident relatives (“Household Vehicle Coverage”) to determine if they have PIP coverage. If any of these policies have more PIP than what is on the host vehicle, you are entitled to “excess PIP” from these other polices.
  • TIP: Review your health insurance because you have a right to use it to receive medical treatment, but your health insurance will have to be reimbursed for what it paid for accident-related treatment if you receive a settlement from the tortfeasor’s insurance company.
  • TIP: Once you are done with all of your medical treatment and know the full extent of your damages, you can submit a claim to the tortfeasor’s auto insurance company. They will evaluate your claim and pay out a lump sum settlement for your economic damages, pain and suffering. We recommend that you do not settle your claim without consulting with an attorney who practices in the area of personal injury law because once your claim is settled, you will be asked to sign a release forfeiting all rights to any future claims. In Maryland there is a three-year statute of limitations to resolve a personal injury claim or file a case in court.

Last Stop: District of Columbia (D.C.)

 

In the D.C., health insurance has the primary obligation to pay medical bills. PIP benefits that were discussed above can be used to pay if you do not have health insurance or to cover any out-of-pocket medical bills attributed to co-pays and deductibles. However, PIP in D.C.is fully subrogatable, and you may be precluded from making a third-party insurance claim if you elect to use your PIP.

  • TIP: Review your health insurance plan and process all your medical bill using those benefits.
  • TIP: Review the auto policy covering the vehicle that you were in at the time of the accident “Host Vehicle Coverage” and determine if they have PIP coverage. Since this is an optional benefit in D.C. and the coverage can vary greatly, be sure to investigate the availability and exact limits of the applicable coverage.
  • TIP: Review the auto policy for the driver of the vehicle you were in at the time of the accident, your own auto policy, and the policies of your own household resident relatives (“Household Vehicle Coverage”) to determine if they have PIP coverage. If any of these policies have more PIP then what is on the host vehicle, you may be entitled to “excess PIP” from these other polices.
  • TIP: Review the at-fault insured’s auto policy to file a claim in the same manner discussed above. In D.C., there is a three-year statute of limitations to resolve a personal injury claim or file it in court.

If you have questions about information in this series of posts related to Paying Medical Bills Post-Accident, or to speak with a lawyer from our Injury Law department, call 301-340-2020.


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