How to settle auto accident injuries paid by health insurance?
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How to settle auto accident injuries paid by health insurance?
About 4 months ago, my wife was in an auto accident while 28 weeks pregnant. The hospital bill was $15,000. We paid 1.5K towards our deductible and our health insurance paid the rest. Her and the baby checked out OK. I am totally confused as to what we should settle for. Assuming the birth goes OK, do we settle for 3K 1.5 x 2, which is what we paid towards our deductible times a pain and suffering factor or do we need to increase the amount to 15k so our health insurance company does not come after us?
Asked on July 30, 2016 under Personal Injury, North Carolina
Answers:
SJZ, Member, New York Bar / FreeAdvice Contributing Attorney
Answered 8 years ago | Contributor
Your health insurer will not come after you for your medical costs--paying your medical costs is why you have insurance and what insurance does. They may go after the other driver, if the other driver was "at fault" in causing the accident (i.e. driving carelessly, recklessly, DUI, speeding, ignoring traffic lights or signs, texting while driving, etc.), since they could then recover their costs from that person or his/her insurance.
In terms of what you can seek: again, first, the other driver must have been at fault. If he/she was not at fault, he/she was not liable (liability depends on fault) and owes you nothing.
If the other driver was at fault, then the most you could get, if ou sued and won, would be the sum of:
1) Unreimbursed medical costs (e.g. deductibles or copays);
2) Your lost wages, if any;
3) IF your wife or unborn child suffered long lasting or permanent disability, life impairment, or disfigurement--e.g. some disability or impairment lasting many weeks or longer--some amount for "pain and suffering." But if your wife and child are ok and were simply banged up a little, checked out at the ER or hospital, and discharged after a brief stay, there is very little, if any, pain and suffering you'd be entitled to. Pain and suffering is for people losing limb function or sight, or being afflicted by chronic pain, etc. not for people who walk away ok from accidents.
So depending on your wife's and unborn child's conditions, you may or may not be entitled to any pain and suffering.
That does not mean you can't ask for it in a settlement and might not get something, if the insurer or other party would rather pay than fight--but bear in mind that if, as we hope, everyone is ok, the deductible may be all you would be entitled to. And often, if you settle without the need to actually go through with a lawsuit, you accept less than the full amount because you are saving the time and cost of litigation.
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