Depending on the nature of the accident, the first insurance claim should be against the insurance of the at-fault party. For example, let’s say you’re hurt in a car accident caused by the other driver. That person’s insurance is responsible for covering your injuries. It is critical that you contact an attorney before you have any sort of conversation or meeting with the at-fault insurance representative.
Should you find out that the other party was uninsured, the next point of contact for your coverage is your insurance company. If you have Personal Injury Protection (PIP)then be aware that this covers not only your medical expenses but lost wages. However, you may need to pay your co-pay or deductible when you access your PIP coverage.
If you’re facing surgery, rehabilitation or other therapy for a life-altering injury caused by someone else’s negligence in their home or on their property, their home owner’s liability insurance should cover your injuries from the event. If they are uninsured or under-insured, your health insurance should provide you with treatment while you’re waiting on the outcome of your case, though you will need to receive refusals or “declines” from these other insurance options before applying your care needs to your personal health insurance.
Depending on the extent of your injuries and the ultimate result of your case, your insurance needs may change. For example, if you are assessed after all possible medical treatment and this review determines that you are fully disabled, you will eventually be eligible for Medicare upon receiving your disability status.
While your case is pending, there should be no gap in your health insurance unless you are unable to pay to keep your health insurance in place. Depending on the insurance status of the person who harmed you, the first path to place claims are their insurance, then to seek coverage from your own insurance. Should you need to turn to your own health insurance for medical care related to an injury, your insurance has a right to reimbursement from any final settlement. In fact, if and when you receive a settlement, be aware that your health insurance may file a lien on your settlement to cover their expenses incurred while covering treatment for your injury.
This is called subrogation, and it’s one of the many reasons you want an attorney on your side during this difficult time. Most health insurance companies have subrogation clauses as a standard part of their contract language. Looking at it from their point of view, it makes some sense; if you hadn’t been injured, they wouldn’t be out the money for your care, so if you receive a settlement from the person who injured you, they should get a portion of that settlement. They are not, however, entitled to a full list price payout of any tests, diagnostic tools, surgeries, medications or therapies. Subrogation only entitles your health insurance to be reimbursed for what they actually spent on your care. Because they pay an adjusted price agreed to after negotiation, that is the amount for which they get reimbursed.
Should you be found to be fully disabled, however, you will be eligible for Medicare two years after you start to receive disability payments per the SSA website. Some states offer a gap coverage while you wait for Medicare to be made available to you. Your attorney and your health care providers can give you information on what options are available for your care in your state.
Suffering a life-altering injury at the hands of a negligent person can be very frightening. It’s tempting to want to clear away the damage and anxiety and quickly move forward as best you can. Do not act in haste. Contact an attorney to help you make the best decisions for you and your loved ones. It may lead to a fight, but with the right team on your side, it’s a fight you can win.