Hello, everyone. This is Robert Mansour. I wanted to make a brief video today about how to pay for your medical care when you're involved in an automobile accident. This is a very important issue and you cannot enter into it lightly.
The firs thing that I do when I contact a client or when they talk to me is I say, "Okay. If I take this case, we have to decide how are we going to pay for your medical care." There are several options. If you have health insurance, that might be one way to do it. Have your health insurance pay for the medical care. Keep in mind that in most cases, your healthcare insurance company will have a right to be reimbursed if you recover money from the responsible party.
If your health insurance company pays out $2,000 for your care and you recover $5,000 from the responsible party, you may have to repay your health insurance company if that is the case. That hold true for Medicare and Medi-Cal and most of the major health insurance companies out there.
If you have medical payments coverage under your automobile policy, you might also be able to use that. Medical payments coverage is like having health insurance attached to your auto insurance policy. Usual policy amounts are $2,000, $5,000. I have seen some that are $25,000. It all depends on what you have if you have it available. The nice thing is that you can use that money to pay for your healthcare in many cases.
Now, here's the thing. If your auto insurance company pays based on that provision, they have a right to reimbursement as well, and you have to make sure you take care of them at the end of your case.
Another thing you can do is proceed on a lien basis, lien. What does that mean? That means that if you don't have health insurance and you don't have medical payments coverage, you might be able to get care from certain doctors who specialize in personal injury matters, or they don't specialize but they know how to do a personal injury case, they know how to handle one, and they accept them.
Here's the thing. A lien means you're going to sign a form that promises to pay the doctor regardless of the outcome of your matter. You can't just tell the doctor, "Well, I didn't win and I lost the case," or "I decided not to pursue and so I don't want to pay you anymore." The doctor is not going to be very happy with that, nor is the physical therapist or the chiropractor or anybody that you hire on a lien basis.
When you proceed on a lien, the doctor is basically fronting his or her services to you with the expectation that you're going to pay them out of the recovery of your case. What you may not realize is that you in most cases, owe the doctor regardless of the outcome of your case.
Contrast that with your health insurance company and your medical payments coverage on your auto policy. In those cases, yes, you have to pay them back, but only if you recover money from the other party. If you lose or you don't recover any money from the other party, you don't have to pay them back versus going on a lien which is essentially a tab at the doctor's office, and having everything done that way in which case, you have to pay those healthcare providers regardless of the outcome of your matter.
So you have to be very careful with how you proceed and how you choose to have those things paid for. Every case is different. In some cases, it makes sense to go one path, in some cases, it might make sense to go a different path. That's one of the issues that I talk about with my clients. Which is the least financially dangerous path for them to go down?
I hope you found this video helpful. I appreciate it very much that you took the time to watch it. Feel free to visit my website, valencialawyer.com for lots more educational information about personal injury cases. Thank you.
VIDEO TRANSCRIPT: Hello, everybody. This is Robert Mansour, and I wanted to make a brief video today about the issue of medical payments coverage. Medical payments coverage is something that a lot of people have under their insurance policy, and they're not even aware of it. Your auto insurance policy may have some coverage for you called "medical payments coverage," or MPC. What that means is, they basically serve as a health insurance company for you.
So, let's say you don't have health insurance. If you have medical payments coverage under your auto insurance policy, they might be able to pay for your health care coverage, or your health care needs after an auto accident. Now, it's important to know what the limits are of your Medical payments coverage.
So for example, you might have $2,000 available to you, or $5,000 available to you. You need to make sure number one that you have it available; and number two, you need to know what the limits are. In some cases, I have seen clients with $25,000 of medical payments coverage available to them. And the nice thing about this is that you can get your health care providers paid more quickly. Some of the health care providers don't understand personal injury cases, and they don't want to work on a lien, for example.
They don't want to defer their payment for later on in a case. They want to get paid now. And if you don't have health care insurance, it might be good to use your medical payments coverage. In some cases, the medical payments coverage will only pay after you've exhausted your health care coverage. So, if you use your health care coverage first and then you have some money left over that you have to get paid, some bills, you can use your medical payments coverage at that point. The other thing is that they may want you to exhaust your health care coverage first, your health care coverage options; or at least demonstrate that you don't have health care, before the medical payments coverage kicks in.
In many cases, and I would say in most cases, the insurance company has a right to reimbursement of their medical payments. So, let's say you recover money from the party at fault. You probably have to repay your insurance company for the medical payments they advanced on your behalf. So, it's not necessarily a freebie. So, let's say your insurance company pays $5,000 to the doctors on your behalf, under your Medical payments coverage. If you recover money from the other party, let's say you recover $10,000, you have to repay your insurance company for the Medical payments coverage that they extended for you.
Now, that is, in most cases, a contractual obligation that many clients aren't even aware of. So, make sure you talk to your lawyer about your medical payments coverage, whether or not it's even going to be available for you. And also make sure you discuss the right of reimbursement that most insurance companies have, when it comes to the medical payments coverage provision. If you don't have medical payments coverage, talk to your insurance professional and see if it will be appropriate for you. In most cases, it's not very expensive and it can be very helpful if you have a personal injury case. Thank you very much for watching this video. I hope you found it helpful.
If you need help with your accident matter, please call my office to learn more and see if we can help you with your personal injury auto accident case. Call (661) 414-7100. Also, visit our Videos page for more educational videos you may find helpful.
Some people are afraid to proceed with pursuing a personal injury claim because they are afraid to get stuck with medical bills and attorney fees they cannot pay. Here are some things worth keeping in mind regarding these important issues.
First, in most cases, personal injury lawyers work on "contingency" which means they don't get a fee unless they recover compensation for you. This compensation is usually obtained from the responsible party's insurance company. However, in some cases, the compensation comes from your own insurance company (this happens if the other party didn't have insurance or not enough insurance, provided you have "uninsured" and "underinsured" motorist provisions on your auto policy).
In any event, if you don't recover anything, then you don't owe a fee to the lawyer. I've worked on some cases for 2 years before getting a fee. In most cases, you can choose to dismiss your claim for one reason or another - if you didn't get any recovery, then you still don't owe the lawyer. A good lawyer will not force you to proceed with your claim just so he/she can get a fee.
Clients worry about getting stuck owing a lawyer for services. In most cases, it isn't much of an issue. You might be on the hook for some "costs" such as filing fees etc., but before filing a lawsuit, there are rarely many significant costs. In many cases, the lawyers will waive minor costs as business expenses (i.e., obtaining the police report, getting medical records, photo printing fees, etc.).
Next, clients worry about owing the doctor money for treatment. While it is true that most doctors won't work for free, there are strategies you can employ to minimize the risks. Here are some common routes to entertain:
First, you can ask the doctor to treat you on a "lien." That means the doctor will provide treatment to you without up front costs. In most cases, they will do so only if you are represented by a lawyer. They will submit a bill to your lawyer after you conclude treatment. The bill is usually paid out of proceeds obtained when settling with the responsible party. However, if you don't recover any money from the responsible party (or from your insurance), you are still technically on the hook for the doctor's bill. The "lien" approach is good when you don't have any other insurance resources and/or if liability is clearly established in your favor.
Therefore, if that is a concern (i.e., liability is an issue and there is a danger the other party won't pay, or there is another concern you won't be able to pay the doctor), then you should consider having your medical bills paid by your health insurance company. If you choose to do that, the responsible party won't entertain the full amount of your bills, but they will instead consider the amount accepted as payment in full. That can be a fraction of your actual bills. Also, it depends if the health care provider has an agreement with your health insurance company (i.e., they are a preferred provider, etc.).
That means if your actual bills are $3000 but your health insurance paid $1000, the insurance company for the responsible party will only consider $1000 as your bills (if your provider accepted it as payment in full). That may be a detriment, because your case will seem "smaller" and less significant as a result. However, on the positive side, you will have peace of mind knowing your bills have been paid. Make sure your provider will accept the payment as payment in full if this is important to you.
Now, one more caveat to consider - your health insurance will expect to be repaid in most cases. You have to reimburse them from any settlement you may get. This expectation of reimbursement is usually contractual. The silver lining is that, in most cases, you only have to pay them back IF you recover any money. If you don't recover any money, then you generally don't have to reimburse them. That way, your medical bills are paid and you don't have to worry about any outstanding medical bills.
Finally, you can have your bills paid by your Medical Payments Coverage, if you have that kind of coverage under your auto policy. This is known as MPC. You need to find out if you have that kind of coverage, and you also need to learn how much you have. Typical amounts are $2000, $5000, and sometimes more. In some cases, your auto insurance will only pay secondary to any health insurance you may have. In other cases, they will go ahead and pay regardless.
Therefore, your health care provider can bill your auto insurance instead of billing your health insurance (very helpful especially if you don't have health insurance). Again, that doesn't mean your MPC will pay every dollar billed, but you need to ask the health care provider if they are going to accept payment from the MPC policy as payment in full or if they are going to hold you responsible for the balance. You see, your health care provider may have a contract with your health insurance company to accept payments as payment in full, but they probably don't have the same agreement with your auto insurance company. Similarly, your auto insurance company will expect to be repaid the MPC benefits IF you recover from the other party. If you don't recover anything from the other party, you generally don't have to repay your auto insurance company for payments made under the MPC provisions. Therefore, your medical bills are paid and you don't have to worry.
Just keep in mind that how your bills are paid is important. Strategically, you may consider one avenue over another. Just talk to your lawyer about the pros and cons of each approach. At the end of the day, you want to proceed cautiously, and your lawyer should offer you some direction about which path to take.
If you have been involved in a serious car accident and you want some legal advice, call Robert Mansour at (661) 414-7100 for a free consultation. Robert serves Santa Clarita, Valencia, Saugus, Canyon Country, Newhall, Stevenson Ranch, Castaic and surrounding communities.
If you received health care immediately after your accident (i.e., visit to the emergency room, hospital, doctors, etc.), try to get your hands on those medical records AND billing.
If you get into a car accident, your lawyer can't simply contact the insurance company and say, "Hey, give my client $10,000!" The insurance adjuster is going to want "evidence" that substantiates the claim for settlement. They aren't going to write you a check simply because you're a nice person.
While your lawyer can usually get the records and bills, there are times when they might run into a snag. Lawyers will usually have little trouble getting medical records and bills from doctors and facilities that understand the personal injury process and the lawyer's need for records and bills. They "get it." However, in some cases, it will be difficult for your attorney to get the records and bills. Some facilities are essentially downright unresponsive. In those cases, a simple phone call or letter from you to the facility/doctor will be very helpful. Under the law, you are entitled to your own records and bills. They have to provide them to you (they might mail them or you can pick them up). They can't simply ignore you! They might charge you a modest copying fee but otherwise, there are no other charges.
Also, remember that bills and records are two different things. Many times, they will send you one without the other. You may need to contact two entirely different entities to get both. Sometimes the billing is handled off-site. It's not fun but it's necessary when it comes to presenting your claim.
Therefore, while your lawyer can usually get your records and bills, there may be times when your assistance is helpful. Your attorney should ask you to get involved if he/she anticipates a problem with a particular health care provider.
Sometimes clients call my office and they say, “Rob, I was involved in a personal injury accident. I really don’t know what to do.” A car accident occurred, T-bone, rear-end, whatever the case may be, and they really don’t know what to do so, and so I want to spend a few minutes here as I talk to you from my office giving you some ideas about what to do if you were injured in an automobile accident, and you have a claim that you’d like to bring. So there are a few things to keep in mind.
First things first, make sure that you take photographs of every vehicle that was involved in the accident. If you have the energy at the scene of the accident, and you have a camera or perhaps a cell phone that has a camera, a camera in it, take pictures but not only of your vehicle. I have a lot of clients they bring me lots of pictures of their vehicle only, and that’s fine, and that’s very helpful, but if you can, take pictures of all the other vehicles that were involved in the accident as well. The other thing that I would add is take pictures from several different angles because a lot of times because a picture is a static image, and it’s a two-dimensional image, sometimes it’s very difficult to assess the damage just by looking at it in, from one angle. If you’re taking a look at a vehicle with your own eyes you have three-dimensional ability, and you can, you can kind of assess the damage a little bit better.
So if you’re taking a photograph, make sure to take photographs from several different angles so that you’d better tell the story. If you don’t have photographs, it’s not terribly helpful when you’re trying to convince a jury or an adjuster or anybody else of the severity of the impact. So pictures really do tell a thousand words so to the extent that you can take photographs. If your vehicle has already been towed to a yard, see if you can get to that yard or have a friend or a family member go to that yard and take some pictures of your vehicle and the more the merrier. There really is no limit as to far, as far as how many pictures are good. Also, again, pictures of the other vehicle are very, very helpful.
Also, you want to make sure that you provide your lawyer with all of the auto insurance information. We need, as your attorneys, we need to know your policy number, what insurance company you had, whether your insurance was in force at the time of the accident and also what kind of coverage you had in your insurance policy, and that information is very important because it provides us with a contact person.
Also, it’s very helpful to find out if you had something called medical payments coverage. Sometimes your own insurance company will pay for your medical bills if you need to turn to them to do that. Of course you can use your own health insurance as well, and sometimes you can go to a doctor and see them on what’s called a “lien” basis, and a lien basis means that the doctor will provide you with physical therapy and care, etc. if it’s appropriate, and that doctor will expect to be paid later on when you settle with the responsible party. But anyhow, get all of your insurance information that when your attorney contacts your insurance company, they have all the information they need. Also, very important, make sure you have the insurance information for all the other parties involved to the extent that you can. Sometimes you’re unable to get that at the scene of the accident, and I understand that.
Many times that will be on the police report. Speaking of which, very important, if there is a police report, please provide it to your lawyer. It’s going to have a lot of important information in there, sometimes insurance information, also the officer’s opinion about the responsible party, sometimes there is information in there about witnesses, the severity of the impact, and how the accident occurred. So the police officer’s report, which by the way, is not the definitive answer, if you will, as to who is at fault, but it’s helpful, and it’s one of the pieces of the puzzle that will be very helpful to your lawyer. Sometimes you won’t have the police report. Instead you will have a police report card that the officers give you at the scene and it will have the police report number on it. Give that to your lawyer so they can secure the police report from the responsible agency. Also sometimes officers take photographs at the scene of the accident and your attorney can obtain those as well.
Another thing that you can think about is property damage estimates. If your car has been damaged, make sure you get a property damage estimate for your vehicle, maybe even two. Take it to a shop, a dealership, wherever you want to take it and make sure you get a detailed property damage estimate because sometimes people say, “Well it was a total loss.” Well, a total loss is fine that helps me a little bit, but a total loss doesn’t really mean much except that the value of the car was less than what it cost to fix the car. So if you have a $1,000.00 vehicle, and you have $1,500.00 worth of damage to that vehicle, which isn’t very difficult to do by the way, you might have a total loss. But that doesn’t really tell the attorney anything about what exactly was damaged in the automobile accident.
Your property damage estimate is very helpful because it’ll show whether there was a any frame damage, any damage to the doorframe, any damage to the axle of the vehicle, wheel alignment issues, etc., bumper support structures. Those kinds of things, those kinds of bits of information in a property damage estimate can be very helpful to the attorney when they’re advocating for you. So even if you’ve been told, “Oh, it’s a total loss,” see if you can get a property damage estimate nevertheless. Sometimes your own insurance company will provide with a detailed analysis of what was damaged in the accident, and of course, it’s unlikely, but if you have a property damage estimate from the other party, provide it to your lawyer as well.
Also, you should get medical care right away. Don’t wait around hoping that you’re going to feel better. Sometimes people try to tough it out, and all they’re doing is hurting their own case because the longer you wait from the date of the accident to when you first seek medical treatment, the longer you wait the more the responsible party, the insurance company for the responsible party, is going to doubt whether you had any injuries at all. So make a list of all the doctors that you go to and make sure that you seek medical care right away even if you just make sure you’re all right because if you wait too long, they will doubt whether or not you were injured. And also, every time you go to the doctor after an automobile accident, make sure you mention to the doctor why you’re there. I have many clients they go to the doctor and they say, “Oh, my back hurts or my neck hurts,” or something like this, and the doctor provides care, but they never mention to the doctor that it was because of an automobile accident, and as a result, the absence of that information, some insurance adjusters will take a look at that and say the absence means that it wasn’t related to the car accident. You were there for some other reason. So you want to make sure you always provide your healthcare providers with the information that is relevant to the matter so that it ends up in your medical file.
Also, when you go to the doctor, make sure that you mention everything that bothers you. Start from the head and make your way down even if you’re not terribly sure, make mention of it to the doctor because sometimes some people try to tough it out and they don’t mention their back because, “Oh, it, I don’t want to trouble the doctor or, or I don’t want to trouble the physical therapist,” but the problem is that all they’ve done is hurt their own case because once again, the absence of information in medical records, as far as some insurance adjusters are concerned, the absence of information means it never happened. So make sure that you always are very mindful of what you are telling your healthcare professionals, and plus the healthcare professional wants all the information so they can provide you with the best care.
Finally, if there were any witnesses to the accident, make sure that provide that information to your attorney. Sometimes the witness information is in the police report, but sometimes it’s not. Any passengers in your vehicle might also be witnesses to the accident. So once again, it’s very important to provide your lawyer with more information than less. Some people go to the lawyer and they sign up with the attorney and they think everything’s going to happy magically. Not quite. We still need assemble information because remember, insurance companies don’t pay out of the goodness of their heart. I mean of course there are always very nice adjusters and in many cases, they’re trying to do the best job they can, but they don’t write you a check just for fun. They need to have evidence. They need to have information, and so you need to provide that information to your lawyer so your lawyer can advocate for you.
Oftentimes, my clients are very concerned with what their case is worth. In their minds, it is usually worth a great deal. Part of my job is to bring my clients back down to Planet Earth. I will not make false promises or inflate your expectations. No one will ever be able to see the case through your eyes. That said, you must bring yourself out of that mindset. You can think your case is worth a million dollars, but it doesn’t really matter what you think. What matters usually is what a jury is apt to think, or before that, what an insurance adjuster assigns to the case. However, people still ask me, “How much is my case worth?” Well, there is no magic formula.
The best way to determine how much your injury claim is worth when you are injured in a car accident is to look at how an insurance company would value your claim. An insurance carrier will first look at the types and amounts of damages suffered and then at percentage of fault.
This includes medical expenses incurred to treat an injury, such as doctor’s visits, hospital expenses, emergency room expenses, fees for chiropractic care, physical therapy and any type of medical devices that may be needed for your recovery, such as neck braces or crutches. If you don’t have health insurance, there are other ways to get medical treatment.
Medical expenses are typically used as a benchmark for determining the reasonableness of damage awards. Keep in mind you may have a very serious injury, but without medical records and expenses, your case may very well be compromised. That is why I cringe when clients call me six weeks after an accident. They tell me of the serious injuries they sustained, yet they still have not seen a doctor!
Future medical expenses are recoverable if the injured party can show that he or she is likely to need continued medical care as a result of the accident or injury. This amount may be determined by the advice and opinions of your doctors and/or other medical specialists you have seen for treatment. Generally speaking, the future need for medical care must be “reasonably certain” to be incurred.
Pain and suffering damages may be granted for physical pain resulting from an accident or injury. A jury will look at the nature of the injury, the severity of the pain, and how long you are likely to be in pain to determine the amount of damages. Remember that NO ONE will see this case through your eyes. A jury’s evaluation of your case may differ greatly from your own.
If you are unable to work because of your injury, you may recover the amount of money you would have earned if you had not been injured. Lost wages should be documented where possible. If you have a business that suffered, you might have to show an earnings track record before the accident and your earnings after the accident. If there is a disparity, you might be able to prove that as an element of your case.
You may recover damages for lost earning capacity if you can show that your ability to earn money in the future has been impaired. Past earnings will be used to determine an appropriate damage award, but a jury will likely focus on what you might have earned had the accident or injury not occurred. Again, speculation isn’t going to cut it. You will need to demonstrate to an insurance adjuster or jury that your numbers have a strong foundation.
You may also obtain recovery for the value of property that was damaged, including your vehicle and its contents. This also includes loss of use (i.e., rental value for the period of time you were without a car). Please remember that defendant (or their insurance company) is not obliged to buy you a new car! They are only supposed to put you back in the position you were before the accident happened.
Finally, every client has to make a decision at some point. They can either take the offer being made or generally speaking, file a lawsuit against the other party. In some cases, filing a lawsuit makes sense. However, you need to take into consideration the costs of filing a lawsuit. Even though you may recover more money from a jury, you may actually end up with less money when all is said and done.
by Robert Mansour
Robert Mansour is a personal injury lawyer serving Santa Clarita, Valencia,