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Jul 092018
 

Individuals who are seriously injured in car, truck or pedestrian accidents in Philadelphia, PA are often concerned about getting compensated for their medical bills. In fact, it’s probably one of the first questions after a car accident – can I get compensated for medical bills?

Cost of Medical Treatment: PIP or Medical Insurance

car crashUnder Pennsylvania law, individuals who’re covered under an auto insurance policy issued in Pennsylvania are allowed to make a claim for a special type of benefit called Personal Injury Protection (PIP). This covers medical bills up to the amount purchased. Under PA law, there’s a minimum PIP coverage amount of $5,000 required on every policy. This applies regardless of fault. So, even if you’re at fault for causing an accident, your medical bills are covered up to the amount purchased on the policy.

PIP payments are made directly to the medical providers. The bills get submitted directly to the auto insurance company, which in turn, sends payment to the providers.

After PIP is exhausted, the next level of coverage is the injured individual’s own health insurance. These bills are paid according to the terms of the health insurance policy which means that the individual would have to pay co-pays, deductibles, etc.

Who’s at Fault for Causing the Accident?

If another party was at fault for causing the auto accident, the injured individual can seek compensation for medical expenses incurred after PIP has exhausted. Most of the time, a car accident lawsuit will need to be filed against the at-fault party, seeking payment of economic expenses. Any bills paid by PIP would be excluded from this amount.

An injured individual may seek compensation for co-pays, deductibles and other out of pocket medical expenses such as medical supplies, travel, etc. In many cases, the health insurance company will assert a right to be reimbursed for all medical bills it paid out on behalf of the injured individual. This is known as a subrogation claim and if allowed, gets tacked onto the injured individual’s claim against the at-fault party.

If you were at fault for causing the car accident and incurred medical bills, you aren’t able to seek compensation for your injuries. It is important to note that fault is not always clear, especially in car accidents at intersections or on highways. It is important to get your case evaluated by an experienced auto injury lawyer to assess fault and the ability to seek compensation from an at-fault party.

Pain & Suffering Compensation for Serious Injuries

Assuming the accident was caused by another individual, an injured driver, passenger or pedestrian can seek compensation for economic losses like medical bills or lost wages. However, what about pain and suffering?

The answer is pretty complex and depends on the type of auto insurance policy the injured individual purchased: limited tort or full tort. If you elected limited tort, PA limited tort law limits your ability to get compensation for pain and suffering. If your accident falls within certain legal exceptions, you can seek financial compensation for pain and suffering. If not, you’d be prohibited from getting compensated beyond your economic losses.

One of the most common exceptions to limited tort law is the “serious injury” exception. If you suffered a “serious injury,” which is defined as injury resulting in death, serious impairment of body function or permanent serious disfigurement, you can get compensated for pain and suffering. The critical inquiry is how an injury impacted a body part or function. There’s no requirement that an injury be permanent.

As a general rule, if an individual suffered a “serious injury,” the extent of the medical treatment affects the amount of compensation for pain and suffering. More extensive medical treatment usually results in larger claims for compensation.

Here’s an example to demonstrate this point. Two people suffer the same injury, a compound fracture of the lower leg. Both injuries require an ORIF (open reduction internal fixation) surgery with placement of two screws and 6 weeks of physical therapy. Driver A eventually heals and doesn’t need any additional treatment. However, Driver B needs additional treatment. The bone didn’t heal correctly and he needs revision surgery. The surgery results in an infection that causes extensive tissue damage. Even after recovery, Driver B will never be able to walk again without use of a cane or other aid.

Here, the two injuries are the same, but the medical treatment is entirely different. Clearly, Driver B’s medical treatment is much more complex and costly than Driver A’s treatment. As a result, Driver B’s claim for compensation, including pain and suffering, would be greater than Driver A’s claim.

For more info, visit the Car Accident Law Library.

Philadelphia Car Accident Law Firm

Our car accident lawyers represent victims of car, truck and pedestrian accidents in Philadelphia and the surrounding suburbs. Contact us for a free consultation at 215.399.9255.

**This website does not provide legal advice. Every case is unique and it is crucial to get a qualified, expert legal opinion prior to making any decisions about your case. See the full disclaimer at the bottom of this page.