If you were recently injured in a car accident, one of your first concerns may include whether you will be responsible for your own medical bills and other related expenses. Following a car accident, it is important to promptly determine which party is responsible for the accident and whether or not that party has the appropriate auto insurance coverage to compensate for your injuries. However, you should initially use your own health insurance to pay for medical bills. This allows you to take advantage of contractually negotiated discounted rates and ensure the bill is addressed timely. Keep in mind that the at-fault party’s auto carrier does not get to take advantage of your health insurance’s discounted rates, it will have to ultimately pay the whole bill.
This article will provide a detailed discussion and answer the question: does health insurance cover car accident injuries?
What Are the Most Common Types of Injuries Resulting from Car Accidents?
The following types of injuries commonly result from car accidents and require medical treatment:
Head Injuries: Getting into an auto accident can result in head injuries, such as a concussion. A concussion is the result of a person’s head being thrown back and forth (for example, in a head-on collision). If a person suffers a concussion, they might experience severe head pressure, headache, or a loss of consciousness. These injuries can be serious and have long-lasting effects, making it important to seek medical attention right away.
Whiplash: Whiplash is a common injury that can result from a car accident. It is the result of a sudden and unexpected impact that causes the neck to be “whipped” rapidly back and forth. This motion can cause significant pain to the neck muscles and may manifest as neck pain, stiffness, or loss of range of motion.
Broken Ribs: The impact of a crash can result in broken bones. Broken ribs are specifically common because of the way the ribs are positioned in front of the steering wheel. Ribs are very fragile, and broken ribs can be extremely painful and require a lengthy recovery process.
Scrapes and Cuts: Scrapes are probably one of the most common injuries a person might get from a car accident. The impact of your vehicle hitting another car or object can easily result in scratches and cuts. These may not seem serious, but they can still require attention from healthcare providers, especially if there's a risk of infection.
Arm, Leg, and Chest Injuries: Car accidents can also result in arm, leg, and chest injuries. If you crash or are suddenly hit by another vehicle, you typically do not have time to protect your body from the impact. As such, your body may collide with the steering wheel, windshield, or door, causing various injuries. Knee injuries are also common due to their positioning under the dashboard and may require crutches or even the use of a wheelchair during recovery.
Using Health Insurance After A Car Accident
Whether or not you’ll use your own health insurance after a car accident often depends on the laws in your state and what type of insurance coverage applies. The distinction between a “no-fault” and “fault” system plays a major role in determining which insurance—auto or health—comes into play first.
In “no-fault” car insurance states, a driver injured in a car accident will be required to use his own auto insurance coverage to pay for medical bills and other out-of-pocket expenses, regardless of who actually caused the accident. These states typically require drivers to obtain personal injury protection (PIP) insurance, a type of auto insurance policy that covers medical bills and related accident-related losses. In a no-fault system, accident victims are generally prohibited from filing a claim against the at-fault party unless the injuries meet certain thresholds set by law.
Illinois, however, is not a “no-fault” state. Instead, it follows a “fault” car insurance system, where financial responsibility for car accident injuries and damages falls on the person who caused the crash. In most cases, this means the at-fault party (and their auto insurance company) will be responsible for reimbursing the injured party for medical treatment and related losses.
Because Illinois uses a fault-based system, a person injured in a vehicle accident can generally pursue one of the following options to seek compensation:
- File a claim with their own auto insurance provider (if their auto insurance policy includes relevant coverage such as MedPay or uninsured motorist protection)
- File a third-party insurance claim directly with the at-fault driver’s insurance company
- File a personal injury claim or lawsuit in civil court against the at-fault driver
In some cases, your health insurance coverage—whether it’s through a private insurer, Medicare, or Medicaid—may initially pay for accident-related treatment. However, subrogation laws may require reimbursement to your health insurance provider once your car accident claim is resolved. It's also important to review any exclusions or limitations in your health insurance policy before relying on it for car accident injuries.
What types of car insurance coverage are required in Illinois?
Pursuant to 625 ILCS § 5/7-203, all motor vehicle owners in the state of Illinois are required to obtain (at minimum) each of the following types of coverage:
- $25,000 for the injury or death of one person in an accident caused by the at-fault driver
- $50,000 total for all injuries or deaths in an accident caused by the at-fault driver
- $20,000 for damage to the property of another person in an accident caused by the at-fault driver
This minimum liability coverage covers medical bills, property damage bills, and other related costs resulting from other drivers, passengers, and/or pedestrians who are injured in a car accident or have suffered damages from this accident. However, it is recommended that drivers obtain additional insurance coverage just in case they are involved in more serious car accidents that result in more substantial injuries or damages. It is important to keep in mind that once policy limits have been reached, an at-fault driver will be required to pay out-of-pocket for any expenses stemming from the injuries and/or property damages suffered in a car accident.
When would I need to rely on my own healthcare insurance to pay for my medical bills?
As described above, there are 2 big advantages to initially using your own health insurance to cover medical bills. One, you take advantage of discounted rates. Two, the bill is paid right away. The at-fault driver’s carrier will ultimately pay the full amount of the bill, as it does not get the benefit of your discounted rates. Therefore, you are ultimately making money by initially using your own health insurance. Furthermore, even if the at-fault driver’s insurance coverage is insufficient to cover your expenses, they might still be held liable for the entire amount. For example, if the at-fault driver has a car insurance coverage amount of $25,000 for injuries and the expenses associated with your injuries total $100,000, you may be able to obtain the full amount (via court order or judgment) in a personal injury civil suit. However, few underinsured drivers have personal assets sufficient to pay a judgment.
In most cases, the at-fault driver’s insurance will compensate for your injuries, and you may never even have to concern yourself with whether to use your own health insurance. However, there are some instances where you may need to do just that, including the following:
- Where you are unable to determine which party caused the accident and therefore cannot obtain payment from that party’s insurance company
- Where you are unsuccessful at getting the at-fault driver’s insurance company to pay you
- Where the insurance company reimburses you for some, but not all, of your medical expenses, leaving you to cover the remaining balance, including deductibles and copays
What does health insurance typically cover?
If you are required to use your own health insurance to pay for your medical expenses, you will first need to understand what is and is not covered under your specific plan. There are various health insurance plans that one can choose from, all with different types of coverage. However, most health insurance plans provide some of the following types of coverage:
- Ambulatory patient services (outpatient care you get without being admitted to a hospital)
- Emergency services
- Hospitalization (like surgery and overnight stays)
- Prescription drugs
- Rehabilitative and habilitative services and devices (services and devices to help people with injuries, disabilities, or chronic conditions gain or recover mental and physical skills)
- Laboratory services
What does health insurance typically not cover?
As previously mentioned, what is not covered under health insurance depends on the specific plan. However, in general, most health insurance plans do not cover the following:
- Alternative medicine: This includes treatments such as massage, acupuncture, and herbal healing. If you typically use alternative medicine, be aware that the at-fault driver’s insurance company may not provide compensation for these types of medical costs and your insurance may also refuse to cover these expenses.
- Cosmetic surgery: If you are severely injured in a car accident and need plastic surgery, most health insurance plans will not cover these expenses.
- Unapproved medical care: Most often, injured parties are required to receive “pre-approval” from their health insurer before receiving certain types of procedures or treatments. As such, if the injured party obtains a procedure or treatment that has not already been approved, the insurance may not cover the associated costs.
- Experimental treatments or procedures: Similar to alternative medicine, if you are interested in utilizing experimental treatments or undergoing an experimental procedure, your insurance may refuse to cover these expenses. Likewise, it is unlikely that the at-fault driver’s insurance company will reimburse you for these costs.
The Benefits of Working With An Attorney
A car accident lawyer can offer clear legal advice during a stressful time—helping you understand your rights, deal with insurance companies, and avoid costly mistakes. With a trusted attorney-client relationship, you can speak openly about your case, knowing your information is confidential. An experienced personal injury attorney will advocate for your best interests and work to secure the compensation you deserve.
Were You Or A Loved One Recently Injured in a Car Accident?
Contact Our Firm If you were recently injured in a car accident, the Palermo Law Group can help. Our Oak Brook personal injury law firm consists of knowledgeable attorneys with over 25 years of experience handling personal injury cases resulting from car accidents. We will do our best to ensure that you receive fair compensation for your injuries. Please contact us today to schedule a free consultation appointment.