An Overview of Medical Treatment after an Auto Accident in California

Justin H. King, personal injury attorney in the Inland Empire (Riverside and San Bernardino County, California), talks about medical treatment after an accident/injury. 


Transcript: My name is Justin King and I’m a personal injury lawyer here in the Inland Empire. I want to talk to you today about just a few things involving your medical treatment after you’ve been involved in an accident. One, it’s important that you get medical treatment early. On the day of the accident. Sometimes that’s just happens because you’re transported by an ambulance to a hospital or something like that. If you’re not, get yourself to the doctor immediately. It’s important that you document the fact that you were injured in the accident and what physically happened to you as a result.

The next thing is make sure that you follow up with your medical care. If the doctor sets an appointment for you to come in or have a diagnostic test, you need to show up to those appointments. If you don’t, it will later be used against you and they will argue, the other side will argue that you didn’t do all that you could to get better. The next thing is I often have clients come to me and say that their health provider has told them that they can not bill their health insurance because they were involved in an accident. That is completely inaccurate. That is why your health insurance is there, and the healthcare provider can bill your health insurance.

What happens is the health insurance will provide you the care immediately up front. It does take some time for you to get compensated for the other driver. So, while that process is ongoing, you can get your medical treatment from your health insurance and your provider can bill your health insurance directly. Throughout the process of getting medical care, you may have things like co-pays or coinsurance that you have to come out of pocket. Again, it does take some time to get fully compensated from the other driver, the other insurance company and we don’t want to resolve your case early on because all that does is one, it leaves us in a position where we may not know yet what is going on with you medically because you haven’t gone through your medical care.

The second thing is is all those medical bills that you’re incurring, those are costs that we can get from the other insurance company. So, if we resolve your case early, then we’re kind of leaving money on the table for you and we don’t want you to do that. So, if you do have co-pays or coinsurance that you have to come out of pocket for, just keep track of those and when you do retain a lawyer or if you already have a lawyer, provide receipts or credit card bills or documentation of those out of pocket expenses because your lawyer can then go and recover those costs from the insurance company on the other side.

You also want to be mindful of the fact whether you have what’s called medical payments coverage under your auto insurance policy. Many auto insurance policies provide for med pay coverage. Usually it’s up to about $5000 but sometimes it can even be higher. That’s what med pay is there for. It’s an immediate no fault remedy for you to or for your lawyer for you to get money from your auto insurer up to the limit of the $5000 limit or whatever your limit is so that you’re not out of pocket in the meantime for those co-insurance payments or those co-payment while we pursue the action to get money back from the other driver.

The other thing is, clients always ask me, “Justin is it better to treat with a doctor that you recommend to me on the lean basis, which means they treat now and they get paid later after the case settles or is it better to go through my health insurance coverage?” I always tell my clients it’s better to go through your health insurance coverage and there are multiple reasons for that. The first one is just simply a biased thing. If I refer you to a lawyer or if the lawyer is referred by me, it looks like me as the lawyer is directing your medical care and I don’t want that. I want your doctor to be directing your medical care and I want the jury to ultimately believe that your doctors are driving your medical care and your medical decisions.

The second thing is that medical treater who treats on a lean can then be said to be financially interested in the outcome of the case because they only get paid when the case resolves. So, I want to avoid that and I want clients to get treatment through their health insurance. Now, that doesn’t always work. Sometimes health insurers are very conservative with their treatment and they won’t do the necessary tests that are needed to find out fully what is going on with you physically. Another thing kind of creeps in and that is the medical treaters tend not to really care why or how your injury happened. They just want to treat your injury itself. So, they may not do various diagnostic tests that will show why or how your injury happened.

Now, for you personally and for your lawyer and for your case, it is critically important why and how your accident/injury happened. Therefore, if you are getting medical treatment and you are facing either of those two conditions where you don’t feel like you’re getting complete care from your provider or they aren’t doing the diagnostic test that they need to to find out how or why your injury happened, then talk to me, or talk to a lawyer whoever your lawyer is, and tell them that because we do have medical providers that are very qualified, very good medical providers that can treat on a lean. We do interact with various X-ray and MRI facilities that will do those kinds of tests on a lean and we can do kind of a hybrid of treatment where you’re getting some care on a lean and some through your health insurance and that way you’re getting complete care for you and we’re getting all the information that we need to document your case and prove that your injury was caused by the accident.

If you do not have health insurance, please tell your lawyer. Tell me if I’m your lawyer. I will send you out to a doctor to treat on a lean basis because that is your only option if you do not have health insurance. These doctors are good doctors. They will give you good care, but ultimately I come back to the major point that if you are getting solid comprehensive treatment through your health insurance, it is important to keep it that way for the reasons I’ve already talked about and the last reason is this. The medical providers that treat you on a lean, they’re going to ultimately want to get paid back from your settlement. Your health insurance company, they have a contractual right to get payback for what they pay for your healthcare.

I have as a lawyer a lot more legal leverage against your health insurance company to drive how much they are reimbursed. Sometimes up to 50, 60, and sometimes even 70% reductions on what they get paid back at the end of the day and I have some leverage against these lean doctors but I don’t have as much. So, if you can get your treatment through your health insurer, that’s great. Please do that. Obviously if you’re not getting the care you need then we can look at different options. If you have any questions or you’re concerned about your rights after an auto accident, please give my office a call. I’ll be happy to speak with you. Visit my website. There’s information on there and I wish you the best of luck.