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Does an insurance company have to pay my ongoing medical bills?

What is a personal injury claim?

A personal injury claim refers to the compensation an injured person is entitled to receive for his injuries. The compensation amount depends upon the extent of injury the victim has suffered.

In terms of financial aspect, a personal injury claim is known to provide a lot of respite to the injured person:

  • The claim amount helps to deal with the medical expenses of the injured person.
  • The claim amount helps to provide the injured person, some time to get well until he is not fit to work again.
  • Other type of losses and expenses are also known to be covered by a personal injury claim.

Severity of injuries and their effect on claim

A lot of personal injuries can have a profound effect on the condition of the injured person in case they are not attended immediately. It should be noted that different types of injuries tend to have a varying effect on the injured person altogether. While some injuries like the ones leading to torn tendons and ligaments are not known to be life threatening, but still may take a lot of precious time out of an injured person’s life to heal fully. On the other hand, the head injuries, if sustained, may also lead to severe damage to the brain.

Who pays the ongoing medical bills?

In simpler terms, the type of accident one is indulged in, the state one lives in and the type of insurance involved helps to determine the issue of payment of ongoing medical bills of the injured person. The general rule states that the offender does not have to pay for the medical bills on an ongoing basis. He only needs to settle the damages for the accident, he is found guilty for.

However, the only exception is the accidents that occur in “no fault” states.

No-fault state rule: If a motor vehicle accident occurs in a “no fault” state, then the no fault insurance compels the driver’s insurer to pay some or the entire medical bills of the victim irrespective of whether he was at a fault not. Some of the “no fault” states tend to limit the amount to be paid by the vehicle’s insurer company.

When the medical bills surpass the state’s “no fault” limit, the injured person is liable for paying his own bills through his health insurer, state run health insurance program or health care providers depending on whichever is availed by the injured person.

Fault state rule: In case, a person gets injured in an accident in a state that does not consists of non “ fault” insurance, then the injured person himself has to pay his ongoing medical bills. However, in certain cases, the drivers in such states tend to avail medical payment insurance coverage that helps them to sort out their medical expenses up to a certain limit, which is generally less than $10,000.

Slip and fall accidents: In slip and fall personal injuries on someone else’s premises, the injured person is mostly liable to pay for his medical bills, unless the property owner‘s insurance policy has “med pay coverage”. The “med pay coverage” makes the insurance company of the owner responsible to pay the medical bills of the injured person up to the “med pay” policy limits.

How comparative negligence affects a claim?

Whenever a person suffers a personal injury, a lot of factors that lead to the injury are taken into account before the damages are awarded. The comparative negligence rule tends to lower down the compensation amount if the injured person is proved at a fault. Few points need to be glanced at:

  • Was the presence of the victim at the accident spot justified? Did a similar incident occur at that place involving someone else?
  • Was there any possibility that any other person could have saved himself from getting injured at the same spot?
  • Was any awareness created in form of a warning or barrier that was neglected on part of the injured person?
  • Was the victim engaged in any kind of action that plays a role in getting him injured?

Under comparative negligence, if an injured person is found at a fault of 51%, then he is barred for filing a personal injury claim and is liable to pay his own medical expenses.

If you were injured in a PI claim, consider speaking with an attorney to file his lawsuit and avail damages for your injury. Attorneys work on contingency, meaning that if you don’t win your case, they don’t get paid. Contacting an attorney can help your personal injury claim go smoother than filing yourself.