After an individual has incurred a personal injury, what follows are a series of oncoming medical expenses, from emergency room care to ambulance transportation, evaluations, prescriptions, and other therapeutic treatments. Depending on the severity of the injuries, the medical expenses can be astronomical and continue to ‘pile up’ while legal action and a personal injury suit is underway.
We will discuss how personal injury victims manage medical bills, and what kind of compensation methods are available to help the injured cope with thousands of dollars of emergency medical care. In many cases, the compensation depends on the state of residence, and the type of insurance coverage that the victim and business owner have in place at the time of the accident.
Slip and fall injuries can result in mild to catastrophic and life-altering disabilities. The road to recovery for a personal injury victim is not only physical and emotional, but also financial. Learn how other patients have coped with the burden, and what state and federal programs do to help injured victims move forward, rehabilitate, and seek the compensation they deserve.
Health Insurance Matters: The Myth of Medical Expenses and Compensation
There are many misconceptions when it comes to personal injury and responsibility for medical expenses and treatments after the incident has occurred. Some consumers believe that in cases where a business, the government, or other organization is clearly “at fault” for the slip and fall injury (due to negligence), the medical expenses will be paid for by that business. It’s easy to get confused by the process, when most personal injury cases do result in compensation for the injured; but the problem is that compensation may not happen for months, and potentially years, depending on the severity of the injury and litigation.
In the United States, it is illegal for any hospital to refuse emergency treatment, regardless of whether the individual has health and critical illness and gap insurance or not. Thanks to changes in the healthcare system and the Affordable Care Act, many Americans now have even the most minimal of health insurance policies, which can limit their financial liability to $8,000 or less per year, per individual.
How the Affordable Care Act works is that the health care policy guarantees emergency treatment (not including prescription medications or holistic therapies). After an accident, if the injured is enrolled in health insurance, he or she may only incur up to the maximum annual expense, as outlined by their insurance plan.
What Happens When the Injured Has No Health Insurance?
For individuals who have no health insurance in place, the financial situation becomes substantially more precarious. Again, American hospitals are required to provide emergency care and will do so, even for a patient who has no health insurance. The cash cost of the necessary services to stabilize, treat wounds, and ensure that the injured is sufficiently healed. They are not obligated to engage in physiotherapy or other treatments including speech therapy, mobility training, or other modalities to help the injured recover independent movement, and frequently accessing specialists can be very difficult without insurance coverage in place.
The cost of the health care and emergency treatments will accumulate, and the patient and their family will be approached with a payment plan that generally commences within three months of delivery of the medical care. Injured victims who do not have health insurance are often distressed at the costs that accrue – a debt that they are responsible for paying.
If the injured victim is eligible to receive Medicaid or Medicare, the two social programs will cover the expense of mandatory health care needs post-injury. Patients are only eligible for this care if they were enrolled in one of the social healthcare programs prior to the accident. If the injured is unable to work, and he or she is within the low-income guidelines of Medicaid, the individual may be able to apply for Medicaid coverage.
Enrollment for Medicaid is year-round (unlike the Affordable Care Act coverage, which is limited to open enrollment periods). Medicaid covers people with incomes up to 138 percent of the poverty level, which is approximately $17,000, and coverage would be retroactive to the 1st day of the month in which the person applied for coverage. In some cases, medical treatment received up to three months before enrolling in Medicaid may also be covered, depending on the circumstance.
When Will Insurers Compensate Health Expenses?
Until the court case has been successfully resolved in a slip and fall or other type of personal injury suit, there is no compensation for medical expenses provided. The individual is responsible for negotiating an affordable payment plan monthly, and can indicate to the insurer that a personal injury settlement is pending.
Be Ready to Pay Some of Your Settlement Back to Insurers
If you have been awarded a reimbursement sum for your health care treatments, did you know that you must pay back insurance companies for the monies you received? This is often a shock to individuals who successfully claim and win a personal injury suit; federal and state laws outline that the amount you receive in your settlement that directly pertains to health expenses is not payable to the injured (unless the injured has paid cash for all health care services).
If an injured won $500,000 in a personal injury settlement, and $350,000 of the amount was awarded by the court to compensate for health care and emergency hospital expenses, the insurance company (or Medicaid) is entitled to receive $350,000 after the settlement has been paid.
One of the reasons why catastrophic (severe disability injuries) settlements can be so astronomical is that the amount allocated for treatment must be repaid to insurers, followed by legal expenses which are deducted from the settlement, leaving the individual with net proceeds to continue recuperation, or to compensate for lost earnings or unemployability.
It is important for Americans to understand the value of having health insurance, to eliminate the pressures and stress of seeing medical expenses stack up after a personal injury. And it is also essential for them to understand that relief from medical bills, in terms of a settlement, may take months or, in complicated cases, years to resolve.