My Medical Care

Injury cases present a multitude of issues surrounding medical care. What follows are a few of the more common questions. If your particular question is not answered below, give us a call at your convenience (and at no cost), and we will do our best to provide guidance.

 

This can be complicated, but typically, your own auto company's Personal Injury Protection (PIP) coverage pays for your medical care, and that's true whether you are in your car, or struck as a cyclist or pedestrian. If those benefits exhaust, your health insurer typically picks up remaining coverage. In some instances, the PIP coverage on the at-fault vehicle pays where there is no other coverage, or where you are the injured passenger of an at-fault driver.
Even if you don't have your own auto insurance, there can be surprising sources of PIP. For example, simply living with a relative who has PIP may entitle you to PIP. Being a passenger in covered car will entitle you. As noted above, the at-fault driver's car may be a source of PIP. In the most extreme example, even if you waived PIP on a Washington policy, the insurer still must provide PIP for you if the insurer can't produce a copy of your actual signed waiver. The bottom line is it's best to call a lawyer who knows this area well to find out if you have a non-typical route to PIP coverage.
You may see whoever you wish. When PIP is paying, there is no distinction between "in-network" or "out-of-network" providers. As long as the treatment is reasonable and made necessary by the crash, the insurance company will be contractually obligated to pay it, as long as benefits still remain under the policy.
Your medical care is between you and your physicians, but you should know that PIP insurers will become impatient with a lack of progress over time and make moves to cut off your care. For that reason, you need to think proactively. If the same type of care is not helping, you may need to press your doctor about referrals to specialists or for relevant imaging to determine if structural damage has occurred which may explain your lack of progress.
You should call a lawyer. An IME is usually where insurers cut off your care, regardless of your actual injuries. This can have serious effects on your liability case. Fortunately, our office knows how to combat your insurer if it cuts you off, and how to mitigate any damage to your liability case.
If you either don't have health insurance or your health insurance does not cover the care that you need, you will need to either pay your providers out of pocket up front or on a payment plan, or arrange what is known as a "Letter of Protection (LOP)." Under a LOP, providers agree to treat you and wait for payment if you promise to pay for your care directly from any settlement in your case. Not all providers agree to this arrangement, and those that do will often require you to be represented by an attorney the doctor has confidence in.
Unfortunately, this situation often requires a lawyer to untangle things. If you resolve the issue on your own, you will need to convince the auto carriers to give you very clear documents that state why they are not paying at this time and why the health insurer should, and then you must present those to the health insurer. Even if this is done, it may not clear things. Bureaucracies aren't very good at dealing with anything the least bit uncommon to them.
The short answer is "typically you do, and this is usually accounted for in a settlement." Any PIP benefits that an auto insurer pays is typically (but not always) paid back in what is called "inter company arbitration" by the at-fault driver's insurer. Under some circumstances, the PIP insurer can actually force you to protect its repayment in your settlement. Next, any health insurance benefits your company pays must typically be paid back. This is a very technical and uncertain area of law, and often involves negotiations and challenging unrelated care the insurer may be claiming is reimbursable. It is difficult to do much in this circumstance (other than agree with your health company) unless you are represented by counsel.