InjuredIf you have been injured in an automobile accident caused by another person, you may rightly expect that that person’s auto insurance policy will be responsible for paying for the medical treatment you need because of your injuries. But, how that actually happens is often misunderstood. I frequently talk to people that have reached out to the auto insurance company after an accident to ask the adjuster to approve certain medical procedures, like seeing a doctor, receiving physical therapy, and even getting a surgery. When they are told by the adjuster that the insurance company will not approve such measures or give an opinion on whether they will ever pay those medical bills, the injured person may assume that the insurance company is not accepting responsibility for the case. In a way, that is true. Even in a case where the insurance company believes their insured caused the collision, they want to reserve the right to explore any questions about how the accident occurred BEFORE they pay anything. In addition, what the value of the claim is will always be a point of negotiation and dispute. This value evaluation includes the amount of medical bills, whether certain procedures were necessary, whether the charges for those procedures were the proper amount, whether the treatment lasted the appropriate amount of time, and whether any portion of the treatment was related to conditions caused by something else. Because such things can be quite uncertain until all the facts are known (and even then), the insurance companies will not usually accept responsibility or commit to pay for medical treatments before the treatment is actually done.

In addition, it is understandably inappropriate for an auto insurance adjuster to make make decisions about what kind of medical care you may or may not need, where you should get that medical care, what you should pay for that medical care, etc. They are not medical professionals. This conflict is compounded because the insurance adjuster represents the insured who caused the accident, and are in an adversarial relationship with you and should not be giving you advice on how to proceed with your claim.

Even if you did secure pre-approval from the auto insurance company for medical treatment, you should still be using your health care plan for anything it will pay, rather than having the auto insurance pay as you go. The reasons to use your health care plan are discussed in other articles and videos, and, of course, there are exceptions. But, generally, you will be better off both medically and financially if you use your healthcare plan to initially pay the bills instead of having the auto insurance pay it directly (which they usually refuse anyway).

Not only what should happen in a case, but the order in which it should happen, is very important. Usually, you should proceed with their medical care basically in the same way you would if the injuries were not related to an auto injury claim. By so doing, you will make appropriate decisions for your own care, bill your health insurance and pay your co-pays and deductibles (or put them on lien) as you would under normal circumstances, and then deal with the auto insurance company once more of the facts are known. Then, everyone is in a better position to evaluate the claim, and can negotiate a lump-sum settlement, or head to court.

As always, your matter may be different in significant ways, so the general information presented in this article may not be right for your matter, and is not legal advice. If you wish to speak to me about your matter more specifically, or order my free book on auto injury claims, I do offer a free consultation. You can set up that appointment, or order my free book, by contacting Davis Miles McGuire Gardner at 480‑733‑6800 or kfine@davismiles.com.

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