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I understand my auto policy PIP will pay bulk of my medical bills for treatment from my auto accident-who pays the balance?

Princeton, NJ |

My health insurance from work has a high deductible. So am I personally responsible for the deductible + all the co-payments that the auto policy doesn't cover, until I meet my health insurance deductible? Accident was NOT my fault, does the other driver's policy pay for my out of pocket expenses for my treatments, since it was his fault? How do I get compensated?

injured... will need PT. lawsuit threshold applies.

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Attorney answers 9

Best Answer
Posted

If your PIP (auto) coverage is primary to health insurance, all of your bills get run through PIP first. PIP will apply the deductible that you chose (lowest $250; options are $500, $750, $100, $1500; and $2500---NOT recommended), and then apply a 20% co-pay to bills above the deductible. The PIP deductible and co-pays are then run through your health insurance, attaching the PIP explanation of benefits form and a copy of the bill to prove to health insurance that your auto carrier has considered the bill If you have high health insurance deductible, the unpaid medical bills can be paid from your injury settlement. If your injuries will not satisfy the "verbal threshold," sometimes the other driver's insurance carrier will pay them, just to close the file. You must be sure, however, that your injuries will never satisfy the "verbal threshold" before you ask the other insurance company to pay your out of pocket medical bills, because that insurance company will want you to sign an "any and all claims" release, which mean that you can never sue for your injuries.

Asker

Posted

Will a herniated disc meet the threshold? I have had very different opinions on this issue. Also, if I lawyered up and then the attorney decides to drop the case at some point, do I run the risk that the at-fault insurance company will then refuse to pay my out of pocket medical bills (after discovery--that we probably didn't meet threshold).

John Robert Gorman

John Robert Gorman

Posted

A herniated disc will get you to a jury, i.e., the court will let your case be decided by a jury. The defense always argues either that the herniated disc doesn't exist or that it pre-existed the accident. The jury will have to decide whether it exists, whether it was caused by the accident, or whether it pre-existed but was aggravated by the accident such that it became symptomatic. You can still win the case if the jury decides that it pre-existed, but was aggravated. Make sure that you pick a lawyer who would not drop the case, unless something really unusual occurred that would cause him/her to do so. Many lawyers sign a client up, and when they see that the insurance company will not offer a settlement, drop the case. That is not the type of lawyer that you need. If a lawyer files a suit for you, he/she without unforeseen problems should be willing to try the case. Good luck.

John Robert Gorman

John Robert Gorman

Posted

My answer above presumes that you are subject to the "verbal threshold." If you have "no threshold," the foregoing still applies, but if liability is in your favor, then the question merely becomes the amount of the jury's verdict. The artificial hurdle of the "verbal threshold" will not be an obstacle to overcome if you have "no threshold."

Asker

Posted

yes, our policy has the lawsuit threshold. I will call you today!! Thank you.

Posted

You did not state whether you're filing a personal injury claim. if you are not filing a personal injury claim, they may agree to pay them right away, but they will ask you for release of any and all claims against their insured. If you are filing a personal injury claim, they will not pay those bills right away. That would be part of your claim, along with pain and suffering, lost wages and possibly other issues depending upon your particular case. I hope this helps.

Attorney answers to questions are for general purposes only and do not establish an attorney-client relationship. There are always specific facts that are important for an attorney to review before providing advice to a Client. In no way should you rely on the response provided herein to conduct your legal affairs on your own. You should always hire an attorney before you rely on advice provided.

Posted

Any medical expenses that are not paid by the PIP insurer and are not covered by your health insurance can be submitted as damages in your case against the other driver. You should also be aware that your health insurance company can assert a lien against your lawsuit recovery for the amount of the medical expenses it pays. Your attorney must be aware of that and take that into consideration in the settlement of your case.

A full legal opinion and firm recommendations can only take place in a formal consultation with an attorney. These are my general thoughts given the limited information presented and for the purposes of this online forum only. No attorney/client relationship exists.

John Robert Gorman

John Robert Gorman

Posted

Unless you had limited PIP coverage (e.g., $15,000, $25,000, etc.) and your accident-related medical bills exceed that coverage and are not paid by health insurance, the other insurance company is not responsible for your unpaid medical bills---including deductible and co-payment amounts. In that regard, I disagree with Mr Fegley's answer. If your health insurance pays any accident-related medical bills, it MAY have a lien on your settlement, depending on the nature of the health insurance plan.

Posted

You did not state whether you were injured, and whether you have no limitation option on your policy.

Posted

The balance/ co-pay is usually paid from what you recover from other vehicle.

973-984-0800. Please be advised my answers to questions does not constitute legal advice and you should not rely on it, due to the fact that we have never met, I have not been aprised of the facts in you case nor have I reviewed any documents.

Posted

Depending upon the extent of your injuries and treatment, you may also be entitled to pain and suffering. You should seek a free consultation with an experienced personal injury attorney ASAP. Many attorneys, such as myself, work on contingency (you pay no money unless you win). Good luck.

The above is general information only and is not legal advice. The information provided does not form an attorney-client relationship, and should not be relied upon to take or refrain from taking any action. I am not your attorney until we sign a retainer agreement.

Posted

Please clarify if you were injured as a result of this crash and your policy selection with regard to your tort option, (i.e. Limitation on Lawsuit or Zero Tort) However, please note that if you have not opened and are not pursuing a personal injury claim, the insurance company in many cases agrees to pay if you release any and all claims against their insured. If you are pursuing a personal injury claim, said bills will be part of your claim among other factors. Good Luck.

Asker

Posted

injured... lawsuit limitation applies!

Posted

In addition to the above, your out-of-pocket co-pays/deductibles constitute an economic loss. These deductibles and co-pays are recoverable, but may not be covered by insurance.

Please be advised my answers to your question does not constitute legal advice and you should not rely on it, due to the fact that we have never met and I have not discussed the facts of your case with you in detail.

Posted

The answer to your question depends on many factors but as a general rule your personal health insurance can pay bills above your PIP limits. Whether you can collect unpaid bills against the driver that needlessly injured you is more complex. You should consult with a lawyer. I would be more than happy to speak with you for a free consultation. 609-277-3166, http://www.josephmonacotriallawyer.com

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