Simon & Gilman, LLP

Jan 18, 2023

On Behalf of Simon & Gilman, LLP | Jan 31, 2021 | Firm News |

If you sustain injuries in a car accident, you may assume that your health insurance company will cover the cost of medical expenses. This assumption may prevent you from exploring other, and possibly better, payment options.

While, according to ValuePenguin, you can use your health insurance to cover the cost of medical care following an accident, you would, ideally, turn to PIP or MedPay first. There are several advantages of doing so.

Why you should use PIP or MedPay first

There are two good reasons you should file a personal injury protection or MedPay claim before you file a health insurance claim. The first is that with PIP and MedPay, you do not have to pay an out-of-pocket deductible unless you specifically opted for one. A deductible is a dollar amount you must pay before your coverage kicks in. If your cost of care does not exceed your PIP or MedPay coverage limits, you may not have to pay anything for treatment. However, if you use your health insurance, you will likely owe several hundred to several thousand dollars in deductibles and fees.

The second reason you should only use your health insurance as a last resort is because your policy likely contains a “subrogation clause.” Per this clause, your insurance company may be able to recoup any money it paid on your behalf if you later collect money related to the reimbursement of your medical costs. This means if you win a personal injury settlement, your health insurance company has a legal claim to part of it. If you later use PIP or MedPay, you will have to repay your health insurer regardless. Using your PIP or MedPay first can save you a step.

Why invest in PIP or MedPay

Aside from the fact that New York is one of 12 states that requires drivers to carry personal injury protection insurance, there are a few substantial benefits to this additional coverage. As already mentioned, neither PIP nor MedPay requires insureds to pay deductibles, while most health insurance policies do. PIP also covers the cost of lost wages, living expenses and funeral expenses while health insurance does not. With PIP or MedPay, anyone who you named on the policy or who was in your vehicle at the time of the crash can file a claim. With health insurance, only people named on your policy may benefit from coverage.