Personal Injury ClaimOne assumption many people have is that when they are in an automobile accident or suffer personal injuries due to the negligence of another person, their health insurance will cover their medical expenses. While one’s health insurance will cover the medical expenses, there is a hierarchy among insurance coverages that are ultimately responsible for covering your medical expenses before your health insurance.  


Generally speaking, Personal Injury Protection (PIP) and Medical Payments (MedPay) coverage, if you have either as part of your automobile insurance coverage, will be first in line to pay for your medical expenses resulting from an automobile accident.  Once the limits of PIP or MedPay coverage run out, then your health insurance will be next in line to pay your medical bills.  Ultimately, however, the insurance company for the driver who is at fault for the accident will be responsible for payment of the medical bills that you incur. 

You may be wondering if you have a claim when your health insurance is paying your medical bills.  Read on to learn about why it may be to your benefit to talk to a personal injury attorney before agreeing to an insurance settlement.

Washington and Oregon Hold At-Fault Drivers Responsible

Washington and Oregon are “at fault” states, meaning the driver who is at fault for the accident is responsible for the payment of damages, which includes your medical bills. However, the at fault insurance company will not pay your medical expenses until or unless you are ready to settle your claim.  As you can see, this poses a chicken before the egg scenario:  you need ongoing treatment, which requires periodic payment of your medical bills, but the at fault insurance company will not pay for your medical bills until you settle your case, which would cut off any future treatment and related bills.  

In Washington State, the person who is at fault pays for the damages resulting from the accident.  Every vehicle is required to have liability coverage of a minimum of $25,000 per person and $50,000 per accident.  Liability insurance provides coverage for the driver who is at fault.  PIP and MedPay are additional coverages a driver may add to an insurance policy, which are for the exclusive purpose of paying medical bills. 

In Oregon, the at-fault driver is also held responsible.  Oregon requires insurance policies to include a provision for PIP. If there is an accident involving negligence, the at-fault driver’s auto insurance policy is responsible for paying reasonable and necessary expenses. 

The problem with the above is that when you are dealing with another person’s insurance company, they are not going to be eager to pay your expenses.  Often times, they will claim that you are in some manner at fault for the accident, you had pre-existing conditions related to the injuries prior to the accident or that the treatment you received was not reasonable and necessary for your recovery.  They may also claim their client’s policy does not cover your loss. 

Even if you are dealing with an insurance company that seems willing to pay, make sure you are receiving the compensation you deserve.  Talk to a lawyer that handles personal injury claims and is familiar with the obligations an insurance company has to you.

Health Insurance and Personal Injury Claims

When your health insurance pays your claim, they are only paying the medical bills. They do not pay any additional damages, including your pain and suffering. Pain and suffering include the following: 

  • Physical pain
  • Mental anguish
  • Emotional distress
  • Scarring
  • Permanent impairment or disfigurement
  • Permanent loss of mobility
  • Loss of ability to enjoy life as you did prior to the accident

 One additional consideration is that when your health insurance pays your bills, there is generally a co-pay or a deductible, which is a minimum amount of expenses you must cover before the insurance kicks in.  Your settlement will include your medical bills and reimbursement of your co-pays and deductible.

 The recovery you receive from filing a personal injury claim will likely be in excess of the actual medical bills for your injuries. Pain and suffering is generally determined by a number of factors, including, but not limited to, the nature and severity of the crash, the amount of property damage done to the vehicles involved, the extent of your injuries, your treatment, the length of your recovery, the amount of your medical bills, the restrictions and limitations you had during your recovery, and any permanent scarring or disability.  Pain and suffering is not a stand-alone claim, but part of your overall claim for damages.  Insurance companies typically offer a settlement that takes into consideration your medical expenses, but not the negligence of the other driver, pain and suffering, or permanent disfigurement.  

 Before you agree to a settlement from an insurance company you should consult with a personal injury attorney in Vancouver, Washington. They will be able to advise whether the offer you receive is adequate for your claim.  Remember, insurance companies are out to make money, not pay claims. If they can obtain your agreement to a low-ball figure, they will happily pay that to eliminate your ability to later sue for a higher amount. Once you agree to a settlement, you are unable to later file a lawsuit.

PIP Insurance Coverage

In Washington, your medical expenses are paid by your PIP coverage through your automobile insurance so long as you did not waive the coverage.  The typical policy will pay up to $10,000 for medical bills over the course of three (3) years from the date of your accident. Depending on the severity of your accident, the costs can easily exceed this amount.

 For instance, consider you are in an accident that results in a trauma requiring you to be transported by a medical helicopter. The median cost of a medical helicopter ride is $39,000. The median charge per mile for a helicopter ambulance in 2016 was $238 per mile.  Add on to that the cost of the doctors who treat you, surgeries, hospital stay, and rehabilitation and your expenses can easily climb to over $100,000.

 PIP coverage is primary in an automobile accident, which means it pays prior to your personal health insurance.  Your PIP insurer has a subrogation lien and will need to be reimbursed out of your settlement for the expenses it paid on your behalf.    

 It is possible that the PIP carrier will require you to see a doctor of its choosing to determine whether your treatment is reasonable and necessary.  Because they are hired by the insurance, the doctor may determine the severity, or lack thereof, of your condition in a manner favorable to the insurance company. That means your coverage may be cut-off prior to your full recovery.  We see this happening with more frequency as insurance companies prematurely cut off their own insureds from PIP benefits.

Health Insurance Payment Recovery

If you use your health insurance to pay your medical bills and have a pending claim, the health insurance may put a lien on your settlement. This means that you will also need to reimburse your health insurance company for its subrogation lien out of your settlement.  Your attorney may be able to negotiate a reduction in the amount of insurance recovery, depending on other factors in your claim. 

Your settlement in a lawsuit will likely be higher than your actual medical bills. This means that not only will your medical expenses be paid, but you will also receive payment for other damages, including pain and suffering. To determine whether you are obtaining a fair settlement, you should talk to an experienced personal injury lawyer

You May Have A Claim Beyond Health Insurance Payments

You may have an injury from an auto accident, slip and fall, or any other injury that is the result of another person’s negligence. Even if you are receiving payment for medical expenses from an automobile insurance company or health insurance company, you may be entitled to much higher damages.

 Before you agree verbally or sign any settlement agreement with an insurance company, contact the Etengoff Pak Law Group – Vancouver Personal Injury Attorney.  Serving Washington and Oregon from our office in Vancouver, they have more than 50 years of experience and deal exclusively in personal injury cases.

 Call (360) 693-2919, send a text, or use our online form to schedule a free consultation. We handle all cases on a contingency fee, which means you do not pay anything unless we win your case.  Call today to schedule your free case evaluation.