Will the Insurance Company for the Person Who Caused My Injury Pay My Medical Bills?
The insurance company for the person or company who caused your injury provides liability insurance. Liability insurance does not pay for medical treatment.
As an example, homeowner’s liability insurance will cover past and future medical treatment but is paid at the time of settlement or judgment. It will not pay for your medical treatment as you receive it.
Medical Payments Coverage
Liability insurance policies sometimes have a small amount of “Med Pay” (medical payments coverage that will pay for medical treatment or expenses related to medical treatment, like a taxi to a doctor).
I have $5,000 Med Pay coverage on my homeowner’s insurance policy. Med Pay is usually $1,000 to $10,000, but it can be more.
Sometimes, commercial insurance policies and car, motorcycle, and truck insurance policies have Med Pay coverage.
Will My Health Insurance Company Have a Lien on My Personal Injury Settlement?
If you have private health insurance or work for a company with 50 or more employees, New York law will likely prohibit your health insurance company from having a lien on your personal injury settlement.
If you have Medicare or Medicaid, there will be a lien on your personal injury settlement, but Medicare and Medicaid liens can be settled for a lot less than the amount owed.
If you work for a company with 50 or more employees, your company likely has an ERISA health insurance policy or an ERISA-regulated health insurance policy.
If you have an ERISA health insurance policy or an ERISA-regulated health insurance policy, your health insurance company will use a company to place a lien on your personal injury case and collect as much money as they can to reimburse your health insurance company for what they paid.
ERISA liens are negotiated and settled for a lot less, so your health insurance company can’t take all of your personal injury settlement.
Even though they will have a lien, it is still worth getting a personal injury lawyer. Just make sure your lawyer is knowledgeable about ERISA liens. We just settled a case for a client who previously had another lawyer who told her she could settle the case and worry about the lien later. That would have been a disaster.
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Can My Health Insurance Company Make Me File a Lawsuit?
Your health insurance company cannot force you to sue anyone or file a lawsuit to recover the money spent on your medical treatment.
Can My Health Insurance Company Make the Other Person’s Insurance Pay My Medical Bills?
Your health insurance company cannot make the other person’s or company’s liability insurance pay your medical bills. Your health insurance must pay for your medical bills unless you are injured in an accident covered by No-Fault insurance.
It’s possible that your health insurance policy has a clause that says it is a secondary payor. That means that if you have health insurance coverage through another source, that source has to pay first, but a liability policy is not another source.
Some health insurance policies are secondary by law, such as No-Fault in New York, which requires a car’s No-Fault coverage to be primary. Health insurance will pay only after No-Fault stops paying.
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Philip L. Franckel, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York; He has a 10 Avvo rating; Avvo Client’s Choice with all 5-star reviews; Avvo Top Contributor; and a former Member of the Board of Directors of the New York State Trial Lawyers Association.
Robert Plevy, Esq. is one of the HURT911® Dream Team™ Founding Partners at 1-800-HURT-911® New York. Rob began his legal career in 1993 as an Assistant Corporation Counsel defending The City of New York against personal injury lawsuits.