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What is the relationship between auto insurance and health insurance?

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2015-07-17 17:35:07
2015-07-17 17:35:07

It depends on which state you are in. If you are in a no-fault state, the medical provider will typically bill the no-fault (PIP) insurance provider directly. Even in states without no-fault laws, if your injuries arose from a motor vehicle accident and you have personal injury protection or medical payment coverage, your health insurer may refuse to pay your claim until your automobile insurance coverage is exhausted and subrogation (a claim against the at-fault party or their insurer) has been explored.

It is not necessarily true, despite the answer below, that no medical provider is going to bill an auto insurance carrier. I think the responder was generalizing their experience to all 50 states, which just isn't the case.

This is not accurate information. Because the billing will be generated by the medical provider, they are going to bill the most likely source of reimbursement. That will be your health insurance. They (health insurance carriers) are bound by a contract with the insured (usually via an employer) to provide coverage for a wide variety of treatment in a wide variety of venues. The providers don't care much what coverage you have beyond this health insurance and it is NOT their problem or responsibility. They will simply bill the most obvious source. They are in the business of providing medical treatment and not collections. If you don't provide or have health insurance, they will simply bill you. If you DO have coverage somewhere, they still will not bill coverages/policies OTHER THAN HEALTH INSURERS. The health insurance will likely send you a questionairre about this accident (if the information isn't readily available in what the provider submits to them.) The questions will include where and HOW the accident happened and which law enforcement agency, if any, responded and made a report. IT WILL SPECIFICALLY ASK YOU ABOUT YOUR OWN AUTOMOBILE INSURANCE AND WILL ASK IF YOU CARRY PIP OR MEDPAY ON YOUR POLICY. If you do, they will immediately send a Notice of Subrogation rights to the carrier.

      • note that in true no-fault states, this process is quite different; the majority of states are NOT no-fault states and I am responding for those states.****

If you do NOT have Medpay or PIP coverage, then the Health Insurance carrier will send a notice of subrogation rights to the carrier of the at-fault party or the at fault party themselves if they are uninsured. Your questionairre will also ask if you are represented by an attorney for your injuries. If you are, the health ins carrier will also send a Notice of Subrogation rights to your attorney.

Treatment for injuries in an auto accident will be covered by the auto policy first and health insurance would start paying for amounts above the auto policy limits. Other than that, there's no relationship.

You have the option of choosing whether to have your health insurance carrier pay as the primary carrier for medical treatment from an auto accident. (This would apply to injuries to you or your covered dependents, that is. Non-family member passengers would be covered under your usual auto policy limitations or the at fault driver's insurance.) If you want your own health insurance to pay as primary for your or your dependent's medical treatment due to an auto accident, you must specify this provision to your auto insurance agent (they won't ususally offer this, because they lose out on some of the premium). If you have a stable employment and good health insurance coverage history, it makes sense to choose health insurance primary because you save money, and your health insurance is usally easier to deal with when it comes to getting claims paid.

Wow, this is a wide-open question.

Auto insurance can be the insurance of the injured party whether at fault or not, or the insurance of the at-fault party.

Here's a possible scenario.

JohnDriver has an accident, for which he is clearly not liable. There is no dispute about liability between his insurance company and the other driver or the other driver's insurance company.

John is injured and treats with a chiropractor. He has good health insurance and he provides the chiropractor's office with the health insurance information. But John's health insurance company notes that this was an automobile accident, when they receive his bill and treatment notes from the chiropractor.

They then send John a questionnaire. They want to know the following:

Who insures his vehicle; company name and policy number. >> They will then send John's insurance company a notice of subrogation, stating they intend to recover their costs under John's policy. Johns auto insurance company will indeed reimburse them IF John had first party medical coverage on his policy: PIP or Medical Payments coverage.

Who was at fault and, if not John, who insures that person? >> At this point, the health insurance carrier won't really get into who is at fault/liable; they really don't care. They are simply also putting this insurance company on notice that they are going to pay for John's medical treatment, but reserve their right to 'subrogate' (recover damages/$$) from them, the carrier of the at-fault driver.

So, the HEALTH insurance carrier will initially pay for medical treatment, BECAUSE they have a contract to do so. But they will subrogate in the above order, going FIRST to John's carrier, because that is not dependent on who is at fault; the coverage is there and will be available when John is injured in, on, alighting from, his vehicle NEXT, they will go to the at-fault driver's carrier. (If John himself is at fault, they obviously can't take this step, BUT, they will still put this company on notice.) Any medical costs that exceed the coverage available on John's policy will be presented to this company. If John's medical costs exceed the policy limits of the at fault driver, they will put the at fault driver on notice as well AND they will determine if John has any UM/UIM coverage on HIS policy (Uninsured Motorist/UNDERinsured Motorist). They can also recover the excess from that coverage on John's policy. They will also be conducting an investigation and determining liability, to determine who they will PURSUE. Remember, initially, they are just putting everyone on notice.

Now, in the interim, John's Auto Insurancecompany will also be putting everyone on notice for the monies they are paying out under the MedPay coverage. They will attempt recovery from Driver2's Auto Carrier AND from Driver2 himself, if damages exceed Driver2's policy limits....

WOW, are you sorry you asked??? :)

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