If you were in a car accident in Pennsylvania-- you have medical coverage through your auto insurance. But, depending on the amount of medical coverage you purchased, that coverage may "exhaust" or run out.
Whether you were in a car accident on Route 422, or a truck accident on Route 202 or Route 100, if you are a Pennsylvania Resident, you must have at least $5,000 in medical coverage on your policy.
You have the option to purchase more than the mandatory $5,000.
So, after that happens after that medical coverage "exhausts", your health insurance would then have to pay for medical bills. (NOTE: Even if it's the other driver's fault, part of what you pay auto insurance premiums for in Pennsylvania is for medical coverage. It's called "No Fault" or
First-party medical). But, if the car accident or collision is the fault of the other driver, your health insurance will say that the at-fault driver's insurance should pay them back. This is called "subrogation" or sometimes referred to as a medical lien. If you never recover any settlement or money from the at-fault driver's insurance carrier, then you probably would not have to ever repay your health insurer because you have a contract with them. But, once you accept any settlement or recovery against a "third-party" (that is, the other driver's insurer), your health insurance may have a right to a lien (to be reimbursed what they paid out).
This subrogation issue gets complicated. It's important to consult with an
experienced personal injury lawyer in Pennsylvania on this. The at-fault insurance company will not likely explain this to you. They are just trying to get out of your claim for as little as possible.
Whether your health insurer has a right of subrogation will depend on several things. First, what type of plan you have. In Pennsylvania, there is a "Motor Vehicle Financial Responsibility Law" which has as a general rule that insurers can't subrogate. But, there are exceptions. ERISA-based and self-funded plans and certain HMOs may have a right to subrogate. It will also depend on the language contained in your health insurance plan itself.
You have an obligation to notify your health insurer if there is a "third-party" claim and your health insurance has paid any related medical bills. (Probably, because you have exhausted your auto medical coverage). You would then need to determine if your health insurer is asserting a lien, whether it's valid and then find out the amount owed. This can be part of your damages in your case against the at-fault driver's insurance company. Again, these are complicated legal issues that you should consult with an experienced injury lawyer in Pennsylvania about.
David Schreiber concentrates his practice on Pennsylvania Injury Law and Insurance Disputes. He can be reached at 610-792-3304.
