Using Auto and Health Insurance Coverage for Accident Injuries
In New York State, individuals involved in car accidents can obtain reimbursement for the costs of injuries through their automobile and health insurance policies. The state’s no-fault insurance laws prioritize first-party coverage for medical and other expenses in many cases, while preserving the right to sue third parties in cases of serious injuries. This system incorporates mandatory and optional forms of coverage, each offering specific protections.
Under New York law, personal injury protection (PIP) coverage is mandatory for all drivers. PIP covers medical expenses, lost wages, and other reasonable costs incurred due to car accident injuries, regardless of who caused the accident. The minimum PIP coverage required by law is $50,000 per person. This includes payments for necessary medical treatments, rehabilitation, and up to $25 per day for household expenses.
PIP benefits are meant to give individuals injured in car accidents access to needed care without delays caused by disputes over liability. However, this coverage has limits. It does not reimburse for non-economic damages like pain and suffering, except under certain conditions. Victims can step outside the no-fault system and pursue a lawsuit if their injuries meet the “serious injury” threshold defined by law, such as significant disfigurement, fracture or total disability for at least 90 days.
Drivers in New York can supplement their mandatory coverage with optional insurance policies for additional protection:
- Supplemental PIP (SPIP) — This increases the PIP coverage beyond the state minimum, offering additional funds for medical expenses and lost wages.
- Uninsured/underinsured motorist coverage (UM/UIM) — This protects drivers if they are injured by a driver without insurance or with insufficient coverage. It can be critical for ensuring reimbursement when the at-fault party’s resources are inadequate.
- Medical payments coverage (MedPay) — MedPay provides an extra layer of coverage for medical expenses, regardless of fault. It pays 5,000 to $10,000 per person for medical, dental and funeral expenses of accident victims. MedPay can cover costs beyond the $50,000 PIP limit and may fill gaps in health insurance.
- Collision and comprehensive coverage — While primarily for vehicle repair, these can indirectly support injury claims by providing resources to address transportation needs during recovery.
Health insurance often serves as a secondary source of reimbursement after automobile insurance benefits are exhausted. PIP coverage is typically primary for car accident injuries, meaning that it pays first. Once the PIP benefits are depleted, health insurance may step in to cover additional medical costs, depending on the policy terms.
Health insurance might pay for expenses that auto insurance does not cover, such as deductibles or amounts exceeding the auto policy’s limits. Some health insurance policies include clauses that limit coverage for injuries sustained in car accidents, requiring the individual to rely on automobile insurance first. Health insurers who pay out benefits may seek subrogation from auto insurers.
To claim reimbursement from insurance policies, injured parties must document their expenses meticulously and comply with insurance policy requirements. This includes submitting medical bills, proof of lost wages, and evidence of other related expenses promptly. Providing incomplete documentation can jeopardize claims. A qualified personal injury attorney can help ensure maximum reimbursement while protecting the individual’s rights.
At the Law Office Maurice J. Verrillo, P.C. Rochester, we have more than 35 years of experience representing people injured in auto accidents in Monroe and Ontario counties. Please call our office at 585-563-1134 or contact us online to schedule a free 30-minute consultation.
January 5, 2025 Posted in Auto Accidents Tagged car accidents, insurance, reimbursement Comments Off on Using Auto and Health Insurance Coverage for Accident Injuries
