Medical Bills, Prescription Costs, and Other Expenses

What is it for? 

All medical bills that are reasonable and necessary and related to your car accident are covered by the no-fault insurance company.  These medical bills include, but are not limited to, hospital bills, doctor bills, physical therapy bills, prescriptions, ambulance bills, medical appliances such as a wheel chair, walker, back brace, etc., and transportation expenses for your medical appointments.

How much can I get? 

There is no limit on the amount of money that the no-fault insurance company must pay for accident related medical treatment.  The only limitation is that the medical bills must be reasonable and necessary for your care, recovery, and rehabilitation.    For example, a young child who is seriously injured in a car accident may require medical care that costs millions of dollars.  The no-fault insurance company is responsible for paying for these bills.

How long can I get them for? 

The medical bill coverage is a lifetime benefit. There is no limit into the future on how long this coverage will last.    For example, the young child who was seriously injured in the car accident in the example mentioned above is entitled to receive coverage for his medical bills, related to the car accident, for the rest of his life.

How do I file my claims? 

The claim must be submitted to the insurance adjuster assigned to your claim. 

What type of documentation do I need? 

A written medical bill must be sent to the insurance company.   Many times, the insurance company may also request medical records for the bills and also may request that the bills be submitted in a certain format.

How much time do I have to file my claims? 

You should submit your claim for medical bills every thirty days, but claims for medical bills can be submitted up to within one year of the date of the service.

What if I have health insurance?   Who is responsible for paying for my bills? 

It depends on what type of no-fault coverage you purchased.   If your car insurance policy has coordinated medical coverage, your health insurance is responsible for paying your medical bills, and the no-fault insurance company will cover your bills that are not covered by your health insurance, including co-pays and deductibles.    For example, if your health insurance policy provides coverage for 20 physical therapy visits per year, and your doctor has recommended that you receive 30 physical therapy visits for treatment for your injuries from the car accident, the no-fault insurance would be required to pay for the ten physical therapy visits not covered by your health insurance.

WARNING:   If you are covered by an HMO health insurance policy, and you have coordinated medical coverage in your no-fault car insurance policy, you are required to seek treatment from doctors within your HMO plan.    If you seek treatment outside of your HMO plan, the no-fault insurance company may not cover your medical bills.

If your car insurance policy has uncoordinated medical coverage, the no-fault insurance company is primary and is required to pay for all of your medical bills, even if you have health insurance.    Therefore, if you have this type of coverage, you can see any doctor that you want to, even if the doctor is not part of your health insurance plan.

WE STRONGLY RECOMMEND THAT YOU CONSULT WITH AN ATTORNEY IMMEDIATELY AFTER THE ACCIDENT TO REVIEW YOUR CAR INSURANCE POLICY TO SEE WHAT TYPE OF MEDICAL COVERAGE YOU PURCHASED IN YOUR CAR INSURANCE POLICY. 

What do I do if the insurance company refuses to pay these benefits?

If your insurance company refuses to pay these benefits, your only recourse is to file a lawsuit against the company that demands payment for the medical bills.

If the claims are presented within one year but are not paid by the insurance company within one year of the date of expense or claim, it will be necessary to start a lawsuit within that one year period in order to protect your claim.  If you choose to begin a lawsuit against your insurance company for No-Fault benefits, you must file a lawsuit within ONE YEAR of the date on which the last unpaid No-Fault benefit was incurred.

If you fail to file your lawsuit within this one year period, you will lose the right to have the benefit or expense paid.

As you are approaching the one year anniversary of your car accident, and there are any outstanding claims that have not been paid by the insurance company, we recommend that you file a lawsuit prior to the one year anniversary of the accident.