Legal Services > FAQ: After an Accident

Answers to Commonly Asked Questions After an Automobile Accident

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 handling.

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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