Filing Medical Bills: Necessary Step After a Personal Injury Accident

Personal injury lawyers are often asked by clients if they need to file medical bills with their own health insurance company. These procedure questions can be a result of an automobile wreck on another accident. The answer to that question is “yes,” even if the auto wreck or other personal injury accident is someone else’s fault.

Personal injury clients are often confused after a car wreck or other accident about why it is to their advantage to filing medical bills with their own health insurance company. Why would an injured person ask their health insurance to pay when the driver who caused the automobile wreck has liability insurance? Shouldn’t the person who caused the car crash to pay for the medical expenses? There are several reasons why an injured party should still file medical bills on health insurance.

Personal Injury Law and Duty to Mitigate

The first reason to file with health insurance is that North Carolina personal injury law imposes a duty for the injured party to do so.

When a person is injured, they have a duty to reduce their damages if they can do so with a reasonable effort. This duty is called a “duty to mitigate. If the car accident victim can do so with reasonable effort, North Carolina law requires them to do so.

In October 2011, the NC Rules of Evidence were amended to change the amount of damages an injured person can introduce to the amount that it took to satisfy medical bills. For example, imagine a person is injured in a car wreck and goes to a doctor. If the person is insured with Blue Cross, and Blue Cross pays $50 for a bill and the person pays a $5 co-pay, the amount that is admissible at trial would be $55 for that bill. It may be that the bill was original $100, but if this amount was reduced to $55 in insurance and co-payments, then the amount admissible at trial is only $55.

Therefore, since an injured person in a car wreck can reduce, or mitigate, their medical bills by using their health insurance, they have a duty to do so. If a person fails to file their health insurance, then the amount of damages that can be introduced can be reduced by the judge to the amount that health insurance would have paid. This situation could put the injured person in a difficult financial situation, as they may be liable to the medical provider for the full amount, even though they would not be able to recover these full amounts from the defendant and/or his insurance company.

NC Court System Is Involved

A second, but equally important reason to file health insurance is that recovery is a personal injury or automobile wreck case is not absolutely certain. Insurance companies evaluating a personal injury claim and/or juries deciding a personal injury claim in court might decide that some, or even all, of the incurred medical costs, are not accident-related. This scenario is especially common when a person aggravates a body part that was previously injured prior to the wreck. Also, there are various defenses that might apply to a case that would reduce or eliminate liability for the defendant, which could result in no recovery for the injured person. Therefore, if health insurance was not filed, and the injured person did not recover from the case, the injured person could owe thousands of dollars in medical bills that would have been satisfied by health insurance.

Even if a case does not go to trial, automobile and other insurance companies evaluating personal injury claims often refuse to consider an injured person’s medical bills until they have proof of what, if any, health insurance has been applied to the bills. The accident insurance company will often want to review EOB (explanation of benefits) statements to discover the amount paid by health insurance. If health insurance was not filed, many auto and other liability companies are refusing to consider the medical bills.

Client and Medical Provider Interests May Not Be the Same

Sometimes, the medical providers advise the injured person to not file with their health insurance company once they learn the injuries came from an auto wreck. These doctors and hospitals sometimes counsel their injured patients not to file their health insurance and instead attempt to bill the accident/auto liability company directly. The injured patient needs to recognize the motivation of the medical provider in encouraging such action is greed.

The medical provider usually has a contract with the patient’s health insurance to accept a reduced rate. If the medical provider does not file the health insurance, they can hope to collect the full medical bills cost from either the injured patient or the automobile insurance company. In most situations, the medical provider is breaching its contract with the patient’s health insurance when they refuse to accept and file health insurance.

Additionally, by providing this advice, the medical provider is likely engaging in the unauthorized practice of law and could be subject to civil and criminal penalties. (See NC Bar Unauthorized Practice of Law).

For some types of health insurance, namely Medicare and Medicaid, the medical provider has the option of not filing health insurance. In the event that the injured patient is insured through one or both of these types of health insurance, they should still ask the medical provider, in writing, to file their health insurance in order to attempt to mitigate their damages.

Medical Provider Refuses to File: What Should You Do?

If you have been involved in a car wreck or other personal injury and a medical provider refuses to accept your health insurance, you should seek a more ethical medical provider for your care. If that is not feasible, then you should ask the medical provider, in writing, to file the health insurance, and keep a copy of this letter. If that approach is not successful, you can file the health insurance yourself. If the doctor is “in-network” you should also file a complaint with your health insurance company.

Certainly, issues regarding health insurance for injured persons following a car wreck or other accident can be complicated. However, one general rule applies in all cases: If health insurance exists, it should be filed for every visit and for every procedure.

If you have an injury from a car wreck or accident and have questions about filing medical bills with your health insurance, contact the Elmore and Smith Law Firm and we are here to help you.