Auto Accidents: Medical Coverage

Motor Vehicle Accidents
How Insurance Works

How insurance works in personal injury cases and what you can expect for coverage.

Primary Insurance: Your Auto Insurance
A majority of auto insurance policies include Medical Payment (Med Pay) coverage. Med Pay pays medical expenses for you and any passengers in your vehicle who are injured during the accident. There is a maximum amount your insurance company will pay for each person involved in the accident.
*Note: Med Pay will pay for your medical bills up-front at 100% until your limit is reached. Your insurance company will then be reimbursed by the liability insurance.

Secondary Insurance: Your Health Insurance
If you have maxed out your auto insurance Med Pay, your bills will be submitted to your health insurance. Unlike with Med Pay, you will be subject to any co-pays, deductibles, and other costs associated with your coverage. You can include these out of pocket costs into your settlement demands from the liability insurance.  Payments made by your health insurance will be reimbursed by the liability insurance.

Tertiary Insurance: Liability Insurance
This is the auto insurance of the at-fault party in the accident. While the liability insurance is responsible for your auto and injury bills related to the accident, it will not pay any claims until a settlement is reached. If you do not open a medical claim with your auto insurance and/or do no have health insurance, you will be responsible for the cost of your care until the settlement is reached. Due to this, we strongly encourage contacting your auto insurance and opening a medical claim.
*Note: A settlement may not cover all your bills & out of pocket costs, especially if you didn’t open a Med Pay claim or use your health insurance. For major accidents, you may even need to hire an attorney to ensure you are properly reimbursed. 

Auto Insurance Hierarchy

How insurance works when you’ve been in a motor vehicle accident

South Dakota follows a tort, rather than a no-fault system. This means that someone must be considered to be at fault, and that person's policy must pay for any and all damages. HOWEVER, that does not mean that you should not open claims with YOUR auto insurance. Why? By opening claims with your auto insurance, you will be ensuring that you are being protected from the at-fault (liability) insurance refusing to pay your bills or offering a settlement that does not cover everything you’ve already paid.

After an accident:

1. Contact YOUR auto-insurance. By paying your monthly premium, you have essentially hired this company to help you after an accident. Not only will the help you fix your car, but there is medical pay coverage to help ensure you are protected as well.
   1. By setting up a medical claim with your insurance, you medical bills will be paid up-front with no money out of your pocket until your coverage has been exhausted.
      1. Your insurance company will work to be reimbursed from the at-fault insurance. This saves you the hassle of having to negotiate a settlement and also protects you from settlements that are too low to cover your bills
2. After YOUR insurance’s medical pay is exhausted, you private health insurance is your best option. Much like submitting claims to your auto insurance, submitting to your private health insurance will ensure your bills are being paid up front, and they will work to be reimbursed by the at-fault insurance.
   1. You will likely be responsible for any co-pays, deductibles, co-insurance, and out of pocket maximums. You will have to negotiate these expenses into your settlement from the at-fault insurance.
3. If you have exhausted your medical pay and your private health insurance benefits, then you would begin sending bills to the at-fault insurance.
   1. While they may be responsible for all damages caused in the accident; this is not an ideal situation.
      1. They will not pay until you’ve been released from medical care in relation to the accident. Depending on the severity of the accident, this may not be for a long time, causing you bills to stack up. Many providers may not be willing to sit on the balance and ask that you pay out of pocket for your care.
      2. Once you’ve been released, they will try to make you settle. This amount would likely NOT cover all the expenses you’ve incurred during your care.
      3. There is a chance that the at-fault insurance will try to fight against paying the bills. At that point, you would need to hire an attorney.

Opening a medical claim with YOUR insurance is always the safest route to ensure your bills are getting paid and you are not burdened with dealing with the at-fault insurance company. By paying your monthly premiums, they are obligated to help you with your expenses. If they recommend sending bills to the at-fault insurance, insist on opening a medical claim directly with them. If you continue issues, we would be happy to call your insurance company with you and help you get the claim set up.