Legal Services > FAQ: After an Accident
Answers to Commonly Asked Questions After an
What Medical Insurance Do I Have and What
Does It Cover?
In Pennsylvania, your automobile insurance policy covers
medical expenses when you are injured as a result of the maintenance
or use of your car. The minimum amount of medical coverage
is $5,000, although your policy may have a higher limit, depending
upon what you chose to purchase. This coverage takes priority
over your health insurance. The limits of your automobile
medical insurance coverage must be exhausted before your private
medical insurance will start paying your medical bills. This
is called exhaustion of first party medical benefits.
What Happens If I Use All the Medical Coverage
Under My Automobile Insurance Policy?
(What happens if my benefits are exhausted?)
Your automobile insurance company will notify either you,
my office, and often times your medical providers, that your
medical benefits have been depleted (exhausted). At that point,
your private medical insurance will begin paying your medical
bills. If your private insurance is an HMO which requires
a referral, you want to be certain the medical providers you
begin treating with accept your insurance, as once your car
medical insurance is exhausted, you will need to obtain a
referral to continue treating. If you do not have private
medical insurance, you must inform our office of same immediately.
We will attempt to arrange deferred payment with your physicians,
which means that we would ask them to wait until your case
has resolved before being paid. We would then attempt to recover
your excess medical bills from the party who caused your injuries
in the accident.
Our main concern is that you receive a comprehensive evaluation
and competent management of your soft tissue injury.
What Do I Do If I Receive a Medical Bill?
If and when you receive any medical bills, please call the
medical provider to give them both your claim number for your
car accident, as well as your private medical insurance information,
as referenced above. If you receive a second bill from the
same medial provider, send the bill to our office for further
Will My Car Insurance Rates Increase?
No. Your insurance company cannot raise your premiums if
you were not at fault in the accident. Also, be
advised that in Pennsylvania, the issue of fault is not relevant
for medical benefits.
Do I Have to Go to Any Particular Doctor?
No. You are able to choose the medical provider of your
choice, provided the medical treatment is related to the accident.
If physical therapy is prescribed, physical therapy treatments
must be performed by a licensed physician or physical therapist.
Can I Get Any Money Back That I have Paid
Directly for Prescriptions or Medical Bills?
Yes, as long as the prescriptions or medical bills are related
to injuries sustained in the automobile accident. Please give
all bills you have paid out of your own pocket to my office.
Can I Recover Money for Lost Wages and Income?
Pennsylvania law permits reimbursement of 80% of your gross
income. This is payable up to $1,000
per month for a minimum of five months, depending upon your
policy limits. Most policies have a $5,000 limit, however,
you can purchase more. If you missed work as a result of your
accident, we will request written verification of same from
your employer. We will also request verification of your inability
to work from your treating physician. Your policy provides
that income loss is payable once you have missed more than
five days of work (think of this as a type of deductible).
You are reimbursed 80% because the benefits are not taxable.
If the disability caused by the motor vehicle accident has
you out of work in excess of five months, you will stop receiving
benefits from your insurance company. Any additional reimbursement
for lost wages is recoverable from the person at fault in
the accident (the third party). This may include lost wages
in excess of the $1,000 per month for five months and any
wages lost after the five month period has expired.
James D. Famiglio, Esquire
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