Personal Injury Insurance Claim: Insurance Company Payment of Medical Expenses as Incurred

PAYMENT OF MEDICAL BILLS AS INCURRED

• Third party carrier-the tortfeasor's insurer
  
• Your own auto insurance PIP/MEDPAY
  
• Your own health insurance or HMO (subject to some individual policy restrictions that prefer the insured to first use "available" auto insurance; TIP: if the tortfeasor does not admit liability there is no "available" coverage, hence you can use your medical insurance.
  
• Tortfeasor's homeowner's Insurance for dog bite
  
• Store insurance for premises liability
  
• Self-insured tortfeasor (i.e. Wal-Mart)
  

• Control the Course of Treatment. If you let the tortfeasor's insurer start to pay your bills (and you can tell it is to her advantage to do so by the fact she offered right away), you run these risks on control of your claim:
  
  
  • Control starts with the price tag you will have to satisfy to gain access to interim tortfeasor payments: start with a full recorded statement and a blanket (that means open-ended or no-limit) medical authorization that allows her to go on a fishing expedition through your medical history;
    
  • She can control the course of your medical treatment;
    
  • She has virtual veto power over your choice of doctors and what type of treatment you will receive;
    
  • She can gain easier access to your doctor's staff, and perhaps other records;
    
  • She can control your personal injury insurance claim by terminating payment at any time or making you undergo a so-called "Independent" Medical Examination (IME);
    
  • Advantage: try your own PIP or medical insurance or HMO
    
• Cut off your benefits. Some sources of payment are more likely than others to cut off benefits. Just keep in mind that the real goal of all insurers is to cut off your benefits as soon as they can while appearing fair about it. The auto insurers will employ two techniques discussed below. The goal here is to find the source least likely to interfere with your right to medical benefits. Advantage: try your health insurer or HMO.
  
  
• Outside doctor's "records review". Some sources (mainly your own PIP) will sooner subject your medical records to what is known as a "records review". This is almost as undesirable as an actual IME, but at least one does not have the reviewing doctor making pronouncements on the claimant's character, and alleging exaggeration of your symptoms, as is the case often in IMEs. Advantage: try your health insurance or HMO or the tortfeasor's insurance.
  
  
• Make you take an IME. Some sources (auto insurers, more likely tortfeasor's) are more likely to make you undergo an IME, which will (almost) ALWAYS inure to the detriment of your personal injury insurance claim. Advantage: try your PIP or your health insurer or HMO.
  
  
• Cut you a break on subrogation. Some sources are more likely to compromise on the amount of subrogation that they will claim from your personal injury insurance claim settlement with the tortfeasor's insurer. Advantage: try your health insurer or HMO.
  

• "Reasonable and Necessary" medical costs. Insurance medical coverage is not a blank check for taking all kinds of tests and treatments. Both PIP and tortfeasor's auto insurers will be more restrictive in defining what is caused by the accident. Advantage: try your health insurance or HMO.
  

• Can you choose your own doctor? Your health insurer or HMO may have restrictions on which doctors you can select. Advantage: try your own PIP or tortfeasor's insurer.
  

ADDITIONAL VALUABLE INFORMATION ESSENTIAL TO SUCCESS: A PERSONAL INJURY INSURANCE CLAIM MAXIMUM SETTLEMENT