If you’ve been injured in a car accident was caused by another driver’s negligence, you are likely wondering who exactly is responsible for paying your medical bills related to the car accident—the at-fault driver’s auto insurance carrier? Your auto insurance carrier?

Many of our clients are surprised to learn there is nothing in Tennessee law that requires the at-fault driver’s insurance carrier or your own uninsured/underinsured motorist insurance to pay your medical bills after a car accident.

At-Fault Driver’s Insurance Carrier

The adjuster for the at-fault driver’s insurance carrier will often tell injured claimants to “send me your medical bills as you receive them,” and then they usually follow up with something to the effect of “we will make this right” or “don’t worry, we are accepting liability.” This kind of misleading rhetoric from adjusters leads claimants to believe that the at-fault driver’s insurance company will pay their medical bills related to the accident upon receipt. This is not true. The at-fault driver’s insurance company will not piecemeal settlement monies by paying your individual medical bills. The insurance company for the at-fault driver will not pay out any money on your injury claim unless you agree to release their insured from any and all liability. In other words, they don’t pay you a cent until your entire injury claim is resolved.

Underinsured/Uninsured Insurance Coverage

If the driver that hit you was uninsured or underinsured, you may be dealing directly with your auto insurance carrier regarding your injury claim. Similar to the at-fault driver’s insurance carrier, your uninsured/underinsured motorist coverage will not pay individual medical bills prior to the resolution of your injury claim.

Medical Payment Coverage

On the company’s website, Allstate defines medical payment coverage as follows:

Medical Payment Coverage is part of an auto insurance policy. It may help pay your or your passengers’ medical expenses if you are injured in a car accident, regardless of who caused the accident…Medical payment coverage is sometimes referred to as medical expense coverage or just “med pay.”

Medical Payment Coverage is the only type of auto insurance coverage that will pay your medical bills upon receipt prior to the resolution of your injury claim. Typically, medical payment coverage has a policy limit of $5,000 or $10,000 per person. Whether or not you should use your medical payment coverage to pay your medical bills after a car accident can be a somewhat complicated issue.

Tip: Regardless of whether you decide to use your medical payment coverage or not, one of the first things you should do after a car accident is notify your auto insurance carrier in writing NOT to make direct payments to any medical providers under your medical payment coverage without your explicit approval.

This prevents the emergency room or hospital that treated you after the accident from using part or all of your medical payment coverage. Going straight for an injury victim’s medical payment coverage is the hospital’s way of collecting 100% of the total charges without having to give the contractual discount they have to give your health insurance carrier or even the self-pay discount they automatically give all patients that are uninsured (which is often 50% of the total charges). The reason this is so important to someone injured in a car accident is because any monies paid to health care providers through medical payment coverage or health insurance are subject to what is known as “subrogation” (often referred to as subro).

Subrogation

Basically, subrogation means if your health or auto insurance carrier makes payments on your behalf to cover medical expenses or other damages that are related to the car accident, it is legally entitled to reimbursement of those payments from any settlement you receive from the at-fault party.

Here’s an example of how subrogation could impact your settlement:

Jack and Jill were injured in a car accident that was not their fault. They both go to the emergency room after the accident and incur $10,000 in charges. They both have health insurance and also have $10,000 in medical payment coverage under their auto insurance. They each receive a $30,000.00 settlement from the at-fault driver. However, Jack’s net recovery from the settlement is $27,000 and Jill’s net recovery from the settlement is only $20,000. So why did Jack receive $7,000.00 more than Jill despite having identical medical bills and receiving identical settlements from the at-fault driver? The answer is that Jack’s $12,000 emergency room bill was submitted to his health insurance, who received a contractual discount, which brought the total charges down to $3,000. This means that out of his $30,000 settlement from the at-fault driver’s insurance company, Jack only had to pay $3,000 in subrogation to his health insurance carrier, leaving him with $27,000 in his pocket. On the other hand, Jill’s $12,000 emergency room bill was submitted to her auto insurance and paid under her medical payment coverage, so she received no contractual discount and paid the full $10,000 available under her medical payment coverage directly to the hospital. Basically, out of Jill’s $30,000 settlement, she was required to pay $10,000 in subrogation to her auto insurance company, leaving just $20,000 in her pocket, even though the actual settlement amount was the same as Jack’s.

As I’ve mentioned in previous articles, the best way to get your medical bills paid after a car accident is to submit them to your health insurance carrier. For an in-depth explanation, read “Why You Should Submit the Medical Bills From Your Car Accident to Your Health Insurance ASAP.”

Car accident victims who mistakenly believe that the at-fault driver’s insurance company will automatically pay their medical bills when they send them to the carrier are often unpleasantly surprised to learn those same medical bills have been turned over to collection and their credit score has dropped significantly. If you are injured in a car accident and don’t have health insurance, it’s a good idea to contact the medical providers directly to set up a payment plan so you can avoid having the bills turned over to a collection agency.

1. If You Were Hurt In A Car Accident, Then The Adjuster Is NOT Your Friend.

The adjuster is not your friend. Seriously, they’re not.

The more significant the damages are in your car accident case, the more likely it is that the adjuster contacting you will act like your friend—at least at first. If the adjuster believes the value of your injury claim is below $5,000, they are more likely to be rude and abrupt. (Many of my clients relay in our initial consultation that the adjuster handling their claim actually hung up on them more than once.) If an insurance company perceives that they have a significant loss exposure, the adjuster is most likely going to establish rapport with you and will seem helpful and fair, at least until they start talking about money.

One reason, on high damage injury claims, that the adjuster may be friendly and even appear helpful is that they want you to trust them when they tell you, “you don’t really need to hire an attorney; they’ll just take part of your money.” The adjuster does not want a claimant to have an advocate that understands the ins and outs of the claims process—that would make it more difficult for them to settle the claim for a fraction of its actual value.

When an adjuster says “we accept responsibility,” it does not mean the adjuster will make a fair or reasonable settlement offer to resolve your claim.

Helpful Hint: Insurance adjusters commonly use phrases such as “we accept responsibility,” or “we are going to take care of you” to lull claimants into thinking they will be fairly compensated for all their damages.

Generally, the innocent victim mistakenly believes that if the insurance company accepts responsibility, then the company has a duty to fairly compensate the victim for his or her damages.

Frequently, it is only after the adjuster actually discusses compensation that the personal injury victim realizes that they need an attorney. Unfortunately, that usually happens many months after the accident, and many things that should have been done to document the claim have not been done because the victim expected fairness by the insurer.

2. Communicate With The Adjuster In Writing Not Over The Phone.

Communicate with the adjuster handling your claim by email whenever possible.

During the first conversation with the adjuster, get all their contact information, including email address, physical address, fax number and phone number. Immediately after that first conversation, send the adjuster an email confirming your conversation and stating you are willing to provide them with the necessary information to evaluate your claim, but all communications must be through email. Adjusters like to do their dirty work over the phone. They will be reluctant to use some of their shadier tactics if you force them to communicate with you in writing.

3. Do Not Give A Recorded Statement To The Insurance Company.

What you say can hurt you!

Insurance adjusters will want to take recorded statements from a personal injury victim soon after a car crash. Some may even suggest they cannot process a claim unless you give a statement. This is not true in Tennessee for injury claims made to the other party’s insurer!

Helpful hint: It’s not a good idea to give a recorded statement to an adverse adjuster after a car accident.

However, if you give a recorded statement to an adverse adjuster, be very careful what you say.

The insurance adjuster handling a car accident claim has several huge advantages when dealing with a unrepresented claimant. Adjusters have usually handled hundreds of accident claims. They have been trained in how to take statements from personal injury victims that illicit information from the victim that hurts their injury claim. Do not let them put words in your mouth. A question such as “When did you first see the other vehicle?” is a loaded question because it assumes that you saw the other vehicle prior to impact.

Another area of conversation that comes up in recorded statements is the extent of injuries. Sometimes, a victim may not know the extent of their injuries until after a day or two, or even later. Other times one area hurts so badly that other medical problems are not identified. Also, be weary of an adjuster that asks you if you are okay. Many of my clients have had an adjuster justify low-ball settlement offers by saying “You said yourself you were okay when I spoke to you immediately after the accident.” Avoid giving statements while taking medicine.

If you give a recorded statement to the adverse adjuster, follow these guidelines:

• Do not volunteer information.
• Do be truthful and concise
• Don’t guess if you’re not sure.
• Qualify your answers when appropriate.

4. Do Not Sign A Medical Authorization For The Insurance Adjuster To Obtain Your Medical Records.

The insurance adjuster will try to get you to sign a medical authorization allowing them to get your medical records. Don’t do it. Adjusters use medical authorizations as a way to try and dig up something in your prior medical history they can use against you. If you look closely at the medical authorization it usually gives the adjuster complete access to your medical history and your employment records. You should get copies of your medical records and billing related to the wreck and provide them to the adjuster.

5. Finish Your Medical Treatment Before You Settle Your Injury Claim.

Adjusters often want to pressure injured claimants into prematurely discussing settlement amounts before they are done being treated. Don’t fall for it. Make it clear to the adjuster you will not discuss any settlement offers until you’re fully healed or released from treatment by your doctors.

Underinsured Motorist Bodily Injury Coverage:

Coverage that pays for your bodily injury and related medical expenses when you’re injured in an automobile accident and the responsible party (other than yourself) doesn’t have adequate auto insurance.

Uninsured Motorist Bodily Injury Coverage:

Coverage that pays for your bodily injury and related medical expenses when you’re injured in an automobile accident and the responsible party (other than yourself) doesn’t have auto accident insurance or can’t be located (hit-and-run).

Vehicle Identification Number (VIN):

Your vehicle’s serial number assigned by the manufacturer. The VIN identifies the year, make, model, options and other information that are unique to your specific vehicle.

At Fault:

The degree to which you caused or contributed to an accident, or are “at fault,” and determines whose auto insurance company pays what portion of the damages. The method by which this is determined varies from state to state.

Bodily Injury Coverage:

If you are at fault for an automobile accident, bodily injury coverage, or an auto insurance policy, pays the medical expenses and additional damages for which you are liable for other individuals injured in the accident.

Liability Coverage:

Coverage for damages your auto accident causes to others and their property.

Claim:

When you suffer a loss that’s covered by your insurance, such as an automobile accident, you submit a request to your auto insurance company to pay or reimburse you for expenses, damages, and other financial obligations.

Claims Adjuster:

A representative of an auto insurance company who investigates and settles claims to ensure that all parties—you, your auto insurance company, and any else involved—receive fair compensation.

Collision Coverage:

Coverage that pays for physical damage to your vehicle caused by rolling over or a collision with another vehicle or object, such as a building, fence or telephone pole.

Covered Loss:

Any damage to yourself, your vehicle, or other people or property that is covered under your insurance policy.

Exclusions:

Specifically identified situations that are not covered by your auto insurance policy.

Deductible:

The portion of a covered loss for which you are responsible, as opposed to the portion your insurance company pays. A higher deductible allows your insurance company to offer you lower premiums, as you assume responsibility for a larger amount of loss.

Declaration Page (Dec Page):

An auto insurance coverage summary that lists the following:

• Types of coverage you have elected
• Costs for each coverage
• Specified vehicles covered by the policy
• Types of coverage for each vehicle covered by the policy
• Other information applicable to the policy

Medical Payments (MedPay) Coverage:

This is an optional moto insurance coverage that pays for reasonable and necessary medical and funeral expenses for a person covered by the policy. These expenses must be incurred as a result of an auto accident.

Named Person:

The first person in whose name the insurance policy is issued.

Occasional Driver:

A person who is not the primary or principal driver of the insured vehicle is an occasional driver.

Principal Driver:

The person who drives the car most often is the principal driver.

Property Damage Liability Coverage (PD):

If an insured person is legally liable for an accident, PD coverage pays for damage to others’ property resulting from the accident. PD also pays for legal defense costs if you are sued—but certain exclusions may apply.

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