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Who Pays Medical Bills


Who pays my medical bills after I have been injured in an accident?

So, you’ve just been injured in a motor vehicle accident that wasn’t your fault and medical bills are mounting. Does the other party’s automobile insurance have to pay your medical bills right away? The answer is actually no. At least not until you are able to get a settlement or a judgment against the other party making them legally liable to pay the bills. Even if the accident was clearly not your fault – because any party may deny they are at fault for causing an accident or even that you were injured – they are not automatically legally liable to pay your medical bills.

So, if you’ve been injured who pays for your medical bills? In South Dakota if you are injured in a motor vehicle/motorcycle/semi-truck accident the first party responsible for paying your medical bills is most often your own automobile insurance company. When you purchased automobile insurance you likely purchased medical pay coverage as part of your policy. Following an accident you should immediately check with your insurance company about whether your policy has “med pay” coverage and for how much. Usually medical pay coverage is limited to a certain dollar limit. If your policy has medical pay coverage your automobile insurance is what we call “primary” for payment of medical bills. Primary mean your insurance company has a legal duty pursuant to your contract to pay the first amount of medical bills up to their limit before any other insurance company is legally responsible to make payment on your medical bills.

For example: You have been injured in an accident and are incurring medical bills. You are getting billed and your bills are up to $10,000. If your automobile insurance company has a $5,000 medical pay coverage then your automobile insurance company is legally obligated to pay the first $5,000 towards these medical bills BEFORE any other secondary insurance coverage i.e. health insurance, is legally obligated to pay anything towards your medical bills.

Following an accident you should immediately contact your insurance company and inquire about the amount of medical pay coverage under your policy. Then either the provider or you can forward the medical bills to your automobile insurance carrier for payment of the medical bills up to the amount of your medical pay coverage.

Once your automobile insurance carrier has paid your medical bills up to their amount of medical pay coverage they will no longer be responsible for payment of any further medical bills. Once your automobile insurance company has paid their limit of medical payments they should issue you a letter stating they have “exhausted” their limits (paid out their limit of medical bills pursuant to your medical pay coverage). You should request this exhaust letter from your insurance company and forward the letter to any other insurance carrier who now may be legally liable for payment of the remainder of your medical bills. Once your automobile medical payment coverage has been exhausted and you have health insurance, your health insurance now becomes “primary” to pay the remainder of your medical bills minus any co-pays and deductibles.

If you have been injured in an accident it is very important to immediately get on top of getting your medical bills paid and forwarded to the right insurance company, whether automobile or health insurance company for payment.

At Alvine Weidenaar, our attorneys and staff work tirelessly to get your medical bills paid by the appropriate provider timely as you are treating so you do not have to worry or stress about the mounting medical bills. After all you were injured and are likely already stressed about not being able to work. The last thing you need to worry about is that your medical bills are not being paid.

By Grant Alvine, J.D.

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