I am often asked who pays medical bills after a car accident in Maryland.
The rules are ultimately simple if you understand a little about Maryland insurance law.
Maryland Insurance Law
As most states do, Maryland has a fault system of car insurance. That means that, ultimately, the driver who caused an accident pays for all of the resulting harms, including the medical bills of anyone injured in the accident (other drivers, passengers, pedestrians).
If that driver had car insurance, as most do, that driver’s personal injury liability insurance pays these bills (up to the policy limit).
However, normally, that does not happen until an injury claim is submitted. And injury claims are not submitted until the injured person recovers from her injuries or, at least, recovers as fully as she will. That can be months or even years after the accident.
Although Maryland has a fault car insurance system, Maryland law also provides for an “add-on no fault” coverage which is commonly called Personal Injury Protection, or PIP (which rhymes with sip).
Unless you waived it when you bought your Maryland car insurance, you have PIP coverage. The main things PIP insurance pays are medical bills and (85% of) lost income.
Getting Medical Bills Paid After A Car Accident In Maryland
Therefore, the first place to submit your medical bills after a car accident in Maryland is to your own insurance company to be paid under your PIP coverage. To do this, you open a PIP claim and then give your PIP claim number to your health care providers who will bill your insurance company directly.
Your insurance company will pay your medical bills up to your PIP policy limit which will probably be $2,500. (Some insurance companies offer higher PIP coverages, up to $10,000, so check your policy to learn your limit of coverage.)
TIP: If your insurance company offers a PIP limit higher than $2,500, get the higher limit. The additional cost is small and, if you have an accident, this coverage is very valuable.
If your PIP coverage is exhausted — that is, if the benefits paid for medical bills and lost income exceed the policy limit — you submit your medical bills to your health insurance carrier.
If you have health insurance, your health insurance company will pay your medical bills under the terms of your policy. That means you may have a co-pay or a deductible.
If you do not have health insurance, you will have to pay your medical bills or convince your health care providers to wait for payment until your claim is resolved.
TIP: Since PIP pays for medical bills and lost income, and since there is an alternative way to have medical bills paid — if you have health insurance — it is wise to submit your lost income claim to be paid under your PIP coverage before your medical bills are paid.
What I’ve explained so far is how you get your medical bills paid initially.
But remember I said that the at-fault driver is ultimately responsible for paying all damages caused by the accident, including medical bills.
Therefore, when you make an injury claim against the driver who caused your accident, you can include, as part of your claim, ALL medical bills that you incurred to treat accident-related injuries.
That’s right, even if your medical bills have been paid by PIP or health insurance, you can still recover the total amount of your medical bills as part of your injury claim. (This is one of the few places in the car accident injury claim process is favorable to the claimant.)
(In case you are wondering, this is the principle behind this rule: An at-fault driver should be responsible for all of the harm caused and should not benefit –have their obligation reduced — because you had the good sense to purchase and pay for PIP insurance and health insurance.)
If You Recover From The At-Fault Driver, Do You Have To Pay Back PIP Or Your Health Insurance Company?
You do not have to repay your PIP insurance carrier if you recover the amount of your medical bills from the at-fault driver’s insurance company.
On the other hand, you will have to repay your health insurance company (at least part of) the amount they paid for your accident related medical expenses. Their claim is called a “subrogation” claim. If you are in that situation, contact me to learn more about subrogation claims.
No matter who caused your accident, medical bills incurred as a result of a Maryland car accident are first submitted to your insurance company to be paid under your PIP (no fault) coverage.
If you do not have PIP insurance, or if you do but the amount of your medical bills exceeds your PIP coverage, you next submit your medical bills to your health insurance company.
If you do not have health insurance, you are responsible for the initial payment of your medical bills. Some health care providers will agree to wait until your claim resolves to be paid.
If someone else caused your accident, you can make an injury claim against that driver that includes all of your medical bills, even if they have been paid by your PIP or health insurance.
If you recover the amount of your medical bills as part of your injury claim, you do not have to repay your insurance company for the medical bills it paid under your PIP coverage. But you will have to repay (at least a portion of) the amount your health insurance company paid for your accident-related treatment.
If this is still not clear, contact me to discuss this further.