Personal Injury Protection – What You Need To Know
Car accidents are are an unfortunate reality of life in our society. No matter how safe you drive you never know if someone else may not be paying attention and crash into you on your daily commute. When these things happen, hopefully you have personal injury protection as part of your auto insurance, it can make a big difference.
Hopefully, you don’t have a lot of experience dealing with motor vehicle accidents but even if you do, things can get confusing. With multiple drivers, auto & medical insurance companies and lawyers involved there are a lot of questions that come up when patients are dealing with medical care after a motor vehicle accident.
When you are in an accident of any kind where there is either: a third party that is liable, workers compensation or a vehicular collision (any collision with a vehicle of any nature), commercial insurance will NOT pay your claims or they will ask for any payment back until there is proof there will be no other payor as primary.
When you come in for care following an accident, regardless of who is at fault, the initial payor would be your personal injury protection coverage through your auto insurance policy. We often get people that question why that is, especially if another person is at fault, but personal injury protection is in place to cover your medical expenses after accidents regardless of who is fault. Most auto insurance policies allow you to make a medical claim through personal injury protection without a raise to your rates. Using your own personal injury protection will also get your medical expenses paid real time. Keeping your bills paid in real time helps you avoid built up medical bills ending up in collections and keeps you out of a lien that typically requires legal representation.
If your auto insurance policy does not have personal injury protection coverage and you were at fault, your care will then be covered under your commercial medical insurance after producing proof from your auto insurance company that personal injury protection is not on your policy.
“How does a lien work?”
If you do not have personal injury coverage but the at fault party does have liability insurance, you can still receive care at no cost as a lien. Liens are a temporary collection freeze by the provider until the case is settled. This means that the provider is providing you with care free of charge until your case is settled and it does come at great risk on the providers end. That is why we require our patients to have legal representation in place before we take them on as a lien.
Having legal representation ensures a quicker and more reliable course for reimbursement as it would be in the hands of professionals who know the ins and outs of auto insurance companies, allowing us to focus on your care. If you are a lien and have commercial insurance, we will need proof of no personal injury coverage from your auto insurance before we can bill out to your commercial insurance.
“Do I have to stick to my plan of care?”
Once you have established the billing process for your care, it is very important that you stick to the provider’s recommendations. This is not only to ensure that you get better faster, which is our first and foremost priority, but also that you also have an strong case for the personal injury settlement. Especially in the case of liens, it needs to be documented that you did everything you could to ensure a speedy recovery from the accident. Otherwise, the third party could argue that they shouldn’t have to pay for care that extended past a date you didn’t return for 3 weeks because you didn’t complete your plan of care. It is very important you finish your treatment completely and make as many of the recommended appointments you can.
“Why would I ever need a lawyer? I have personal injury protection.”
Obtaining a lawyer may sound extreme, but in cases with certain companies and with third party (other driver) payors, it can become necessary. Personal injury coverage is a pain in the auto insurance worlds’ side. It is required that they offer it to their customers which is why you have to specifically state you would like to opt out of it in writing. Therefore, companies seem to do all they can to make it difficult for you to use it.
Through the years, companies have gone to further extremes to try and keep that money from their customers. From undercover investigations on provider offices and injured parties, to using an on staff doctor to read through your notes and determine if they should keep paying for treatment. A doctor who has never met you and who probably has a quota of denials to meet. Having a lawyer on your side for personal injury cases is a great asset because you can let them manage the insurance company and they will ensure your care is paid for. That way, you don’t end up in a situation where you are stuck with a huge bill that your insurance wouldn’t cover and have no idea how to go about getting the third party to pay. Lawyers take care of the insurance company and payment so that you can focus on your health.
“My adjuster said they have my back so I trust them.”
The last thing that is important to remember is that although the insurance adjusters may seem like they have your best interest at heart, at the end of the day their job is to save the company as much money as they can on each individual case. Even your own insurance may try and offer you a settlement amount to cut off future care before you’ve completed your treatment. The third party does not need any of your medical information until you’ve completed your care. They don’t need any information other than your demographics and our contacts. They WILL do what they can to trap you into saying something that they can refuse payment for.
At a recent seminar, our staff was told that third party insurance companies are bullying primary insurances to encourage their customers to settle early by saying they will refuse to reimburse care after a certain date. This obviously takes none of your well being into account and is strictly monetary. So be careful what you say and sign when dealing with car insurance companies.
Your health is our number one priority.
The most important part of this process is getting your health back to what you were prior to your collision. Stress can inhibit your healing and the worry over how your visits will get paid for can cause you to not complete your recommended care. That is why we have a seasoned biller on staff who is available to answer any questions you may have regarding this process. We have been down this road before and have experience with all of the different auto insurance companies, so we are here to help when you need it.
If you have any specific questions feel free to Contact Us!
More information can be found at:
Office of the Insurance Commissioner – Personal Injury Protection