Common Medical Billing Issues In Personal Injury Cases

Posted by Benjamin P. Melnick | Feb 05, 2020

I frequently speak with people after an injury, and they tell me they are going to get medical treatment, and that “the other side is going to cover it.” Although that is the way we hope our clients' cases work, the reality is that, with rare exceptions, injured persons bear the up-front cost of medical treatment in their personal injury case.

There are a few resources that can help lessen the financial burden of expensive medical treatment. The hierarchy of which resource pays which bill first is written into the insurance policies. Above all, regardless of how the bills are getting paid, be an informed patient. Know how much your treatment costs, and act like it is your out of pocket money being spent on the treatment, because it is.

In any event, if the injury occurred while you were on the job, your worker's compensation coverage should pay the medical costs. Unfortunately, the coverage is limited, and it will not pay for all the treatments you may hope. For example, we commonly see massage therapy being limited by Washington's L&I. So, you'll have to find another way to pay for the treatment if you feel that you truly need it. 

In auto collisions, even the ones not involving an on the job injury, the first “layer” of coverage is PIP. There can be a lot of problems with PIP, including insurance carriers refusing to pay the benefits, performing a shoddy investigation and terminating the benefits, or simply ignoring the rules altogether and doing whatever they please. An experienced personal injury attorney should have some ideas, depending on the circumstances, for how to deal with those problems. Sometimes a simple phone call and follow-up letter will have the desired effect; sometimes a complaint to the insurance commissioner is warranted; and sometimes you will need to sue your insurance company to ask a court to resolve the dispute.

If you do not have PIP, or your PIP is exhausted or terminated, the next layer of coverage is health insurance. You may have problems meeting your deductible, finding a provider you like who accepts your insurance, or otherwise fitting your treatment into the health plan. Unfortunately, you are largely stuck with the contract—i.e. the policy/plan—you purchased. The only alternative is to act as if you do not have health insurance, and find yet another way to pay for the treatment.

If all other options are exhausted, you have no health insurance, and you are in need of the medical treatment, your path forward is limited. Scott Edwards outlined that path here, including the pros and cons of each possibility. 

Ultimately, I hope that you heed my warning to be an informed patient. The insurance company for the at-fault driver may choose to fight your case hard. Usually, the medical bills are a central feature to that. I recognize the conundrum you are in as an injured person: you need to get the medical treatment for your injuries, but you can't get too much or the insurance carrier may deny the bills. Regardless, there are options for obtaining your medical treatment, and there are options for holding the person or entity who caused your injury responsible. 

About the Author

Benjamin P. Melnick

Ben Melnick joined the firm in 2018. He graduated from Washington State University with a Bachelor's degree in 2010, and went on to earn his Juris Doctorate from Gonzaga University School of Law. In 2016, he was named as the Clark County Bar Association's Rising Star. His practice focuses on personal injury, auto accidents, biking accidents, wrongful death, and insurance disputes. Outside work, Ben likes spend time with his wife outdoors—mostly running, hiking, and skiing—and playing soccer.

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