Who pays for medical care after a California car accident?

We balance the equation by fighting insurance companies for you


If you’ve just been in a car accident, it is important you receive immediate, competent medical treatment. But this medical treatment is expensive, and depending on the severity of your injuries, the bills can pile up extremely fast.

You have several options to pay for medical treatments:

  1. Medical payments coverage from your own auto insurance policy. This is commonly known as “Med Pay.” This is optional coverage that can pay all of your necessary and reasonable medical expenses up to the limit of the policy. A common limit can be $5,000, but you can purchase less, or better yet more than this amount.
  2. Your own health insurance. If you have health insurance, you can use this to pay for your medical services.
  3. The medical service provider. Yes, if you have no other way to pay for medical treatment, some health care providers will allow you to receive treatment subject to a medical lien.

Note that if you use option #1 or 2, or both, that your auto insurance company and/or health insurance company will attempt to seek reimbursement for these costs, if there is another party at fault for these injuries. An experienced personal injury can negotiate these liens down by as much as 30-40% in some cases, saving you a substantial amount of money if you ultimately receive a monetary settlement from the negligent party.

Remember, until the case is settled, YOU are ultimately responsible for any medical bills you incur.

My health insurance paid for medical treatment after my San Diego auto accident. I have now received a settlement, do I have to reimburse them?

In most cases, yes, there is some form of obligation to reimburse your health insurance company if you win your case. The reasoning is, if your health insurance company paid for your medical care, and you win a case where the defendant also pays for your medical care, the health insurance company should receive a portion of those proceeds.

If you were to keep all of the money from the defendant, and not pay back the insurance company, that would result in a "windfall" for you, since you collected it twice.

How much are you required to pay back your health insurance company after your car accident?

The answer to this is very complex. There are seminars and books just on the topic of paying back health insurance companies.

So how much do you have to pay them back? Is it 100%? In California, the insurance company is entitled to a proportionate share if the proceeds are not enough to fully compensate the victim. For example, if you suffered $100,000 in damages (medical bills, lost wages, pain and suffering) but only recovered $50,000, then the health insurance company would be entitled to 50% of the amount they paid.

But, this answer changes if the health plan documents contain certain language. The answer also changes if the health plan was provided by your employer, and it changes even further if your employer actually funds the plan with their own money.

As a practical matter, the companies can be negotiated with. They may reduce their demands to compensate for future medical costs, hardships, additional damages paid, and attorney’s fees. Before you settle any accident claim you may want to consult with an experienced San Diego Car Accident Lawyer to determine whether or not reimbursement of your health insurance company will wipe out any settlement and leave you with no compensation for your injuries.

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