YOU ASK:

Who should pay first in an auto accident health insurance or auto insurance?

WE ANSWER:

What happens, especially in an emergency situation, is that the treatment will be covered by the health insurance. Then, when things have calmed down and it is determined that the injuries were sustained as a result of a car accident, the health insurance company will turn to the auto insurance company (of the person liable) to recover the cost of medical insurance.

As a general rule, car accidents are not covered by health insurance, if there is a car insurance policy that is supposed to cover the medical expense. It should be paid for by the auto insurance - whether of the person at fault, or if the injured party has Personal Injury Protection, then of the injured party. The health insurance will only kick in if there is no such coverage.

No Double-Dipping

There is a principle in insurance that an event cannot claim against two coverages - meaning, only one insurance will pay for one event. If you are injured due to an accident, you can't claim from both your health insurance company and your auto insurance company.

Once you have exhausted the limits of the car insurance, then the health insurance coverage may kick in.

Claims Settlement

What will happen is that the car insurance company will make a settlement to you if:

  • You are covered for personal injury by your car insurance policy
  • The other driver was at fault and his insurance company will pay via the personal injury liability coverage

If you receive the settlement from the car insurance company, you are responsible for reimbursing the health insurance company for what they spent. Otherwise, you may be charged with insurance fraud.

Also, your health insurance may file a lien on your case, so that they can also claim their rightful portion of your settlement. To facilitate this, you can also work with them and give them a promissory note stating that they will be paid once your car insurance settlement will kick in.

Coordinated or Excess Medical Benefits

There are also some states that allow what is called a "coordinated" or "excess" medical benefit. Here, the health insurance is expected to pay first, with the car insurance company paying next for the balance.

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