Can health insurance deny a claim that was caused by an auto accident? (Claims + Laws)

Health insurance can deny a claim that was caused by a car accident, or may pay in advance and be reimbursed from a later settlement. Auto insurance is primary for medical bills after an accident, which means the limits of that policy must been met before health insurance steps in.

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Mathew B. Sims is Editor-in-Chief and has authored, edited, and contributed to several books. He has been working in the insurance industry ensuring content is accurate for consumers who are searching for the best policies and rates...

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years (BBB A+). He is licensed as an agent to write property and casualty insurance...

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Reviewed byDaniel Walker
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UPDATED: May 11, 2020

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Getting into an auto accident is scary. You may have to deal with injuries and filing claims, and the last thing you want to worry about is if you’ll have to pay your own medical bills. You have health insurance, but does health insurance cover car accident injuries? Can you bill health insurance for an auto accident? Can health insurance deny a claim caused by an auto accident?

This article will explain the auto insurance claims process as it applies to injuries. We’ll cover what you need to know about how medical bills are handled after an accident, including what do it if your health insurance won’t cover a car accident.

With the right auto insurance, you can avoid the anxiety of a health insurance company denying your claim. Start comparing auto insurance quotes now by entering your ZIP code above.

What is a health insurance company obligated to pay for a car accident?

Will my health insurance cover me in an auto accident? How are medical bills paid after a car accident? Who pays first, auto insurance, or health insurance? There’s no question that many people experience confusion when dealing with health or auto insurance. Unless you know the practices and terminology of the insurance industry, reading an insurance contract is challenging. Our guide will walk you through this issue step by step.

Health insurance is obligated to pay for any medical expenses if you are injured, get preventative care, and if you get sick. Then, is it possible for a health insurance provider to deny a claim that was caused by an auto accident?

The answer is yes, meaning you may have to deal with a denied claim caused by an auto accident. The reason that some health insurance companies don’t pay has to do with insurance company rules.

The video below discusses why you should use your health insurance after an accident.

Auto insurance laws and health insurance laws may vary. The health insurance company owes the insured person two kinds of payments. The health insurance company should pay its policyholder the costs of health care provided as a result of an accident.

Can my health insurance company take part of my settlement? The health insurance company should get reimbursed when the injured driver recovers general damages (the actual cost of medical and health care) caused by the accident from either the driver at fault or from the auto insurance company. This may be paid to your health insurance from the car accident settlement.

Medical payments sustained by the injured driver or the driver at fault should be covered by the medical portion of the auto insurance policy.

The auto insurance company must pay for the medical care of the people injured in an auto accident.

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Why do health insurance and auto insurance companies deny legitimate auto accident injury claims?

Though auto insurance can pay for medical bills, in some instances, the auto insurance company may deny medical claims payments to the policyholder or other people injured in the accident. Why would an insurer reject a claim?  And what happens if your insurance denies a claim?

Health insurance providers will cover auto accident injuries after the auto insurance claim has filed and issued to the policyholder.

When you’re a no-fault driver, the at-fault driver is responsible for injuries and property damage. Therefore, health insurance won’t cover an auto accident. The next wave of protection for auto insurance policyholders is other coverages such as personal injury protection and medical payment.

If you were the at-fault driver in an accident but have additional liabilities like personal injury protection (PIP) and medical payments (Med Pay), your health insurance may deny your claim.

Does health insurance cover auto accidents in states like New Jersey?

Does health insurance cover auto accident injuries in states with PIP requirements like New Jersey? In the state of New Jersey, for example, motorists generally have PIP on their auto insurance policy. If the PIP and Med Pay doesn’t cover all your expenses, your health insurance may approve your claim. The health insurance company may provide you with a settlement.

The auto insurance companies determine fault by investigating the medical claims of the injured people and concluding the injuries were sustained before the accident occurred.

The company may then threaten litigation, and many of those who are injured may simply back down. Of course, injured persons may hire their own attorney to communicate with the insurance company. Unfortunately, because the parties need immediate help, the thought of future compensation for medical payments (called general damages) may seem less important than simple, immediate medical care.

Here’s a video on how you can respond to a denied claim.

If you’ve ever wondered who pays first, auto insurance, or health insurance, this should answer any questions you have about the order things are done: The auto insurance provider has to respond to your auto accident claim before a health insurance company approves your claim.

How do health insurance companies pay for auto accidents?

Health insurance will only provide compensation when your auto insurance policy limits have been exhausted. If your policy limits are exhausted, hold on to all of the necessary documents during the claim process with your health insurance provider.

For this section, we’ll explore how some of the major health insurance companies respond to auto accidents and claims.

Does Blue Cross Blue Shield cover auto accidents?

Blue Cross Blue Shield does provide compensation for auto accidents for their policyholders. Your medical bills can be reduced when you go to one of their affiliate treatment providers. However, the treatment providers may prefer your auto insurance provider’s claim. As a rule of thumb, use the options from the auto insurance provider before making a claim with Blue Cross Blue Shield.

Does Aetna cover auto accidents?

Like other health insurance providers, Aetna will only provide health insurance compensation when all auto insurance coverage limits are exceeded. Aetna does an additional coverage called the Aetna Accident Plan which gives benefits directly to the member. Aetna policyholders can use the cash benefits to pay for expenses such as mortgage payments, daycare, or utility bills.

Does United Healthcare cover car accidents?

United Healthcare’s rules are similar to those at other insurance companies. Health insurance benefits are secondary to the car insurance policy. United does off an accident insurance plan that can be purchased separately and will pay out when you’re involved in an accident. This plan isn’t related to your regular major medical insurance.

Do car insurance companies pay medical bills directly?

Auto insurance providers do not pay medical bills to doctors, hospitals, or private medical practices regardless of who is responsible for the accident. The auto insurance provider will only pay you, as the policyholder, when a settlement is reached between the claimant (you) and the auto insurance provider.

How does an insurance company disqualify medical claims from an auto accident?

The insurance company may use two ways to disqualify the insured or injured person’s medical claims:

Though the company says it wants only to ensure that the amounts of claims are fairly compensated or to prevent medical claims fraud, injured persons may suffer additional stress during the claims process.

Medical review companies may provide an impartial review of the injured person’s medical records, but that review may be different from the injured person’s side of the story. When the medical review company performs a lot of paid medical review work for the insurance company, their analyses may not be impartial or fair anymore.

When a driver injured in an auto accident seeks medical care, their auto insurance policy should pay the bills.

If the driver doesn’t have auto insurance but does have health insurance, their health insurance policy may decline to pay for their health care. Unfortunately, a health insurance company can deny a claim that was caused by an auto accident. If your insurance denies a claim, you can appeal.

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How can injured drivers pay for needed health care?

What happens if you have a car accident with no health insurance? You have options other than auto insurance and health insurance. Auto accident insurance proceeds are taxable, so injured drivers may take advantage of a pre-tax medical spending account to pay for health care until the auto insurance payment for health care and medical bills gets sorted out.

If you have no medical or flexible health care spending account, contact a local community health care center to obtain medical attention as soon as possible.

Watch this video on how you can pay for medical expenses after an accident.

If no other financial resources exist, you can get medical attention from an emergency room under the Emergency Medical Treatment and Active Labor Act (EMTALA) passed in 1986.

How Auto Insurance Covers Medical Bills

An auto insurance policyholder has a few options when a health insurance company won’t pay for medical bills. We’ll cover those options in this section.

Here’s a video from a law office that explains how medical bills are paid after a car accident.

 

Policyholders can enroll in auto insurance options such as liability, personal injury protection, medical payments, uninsured, and underinsured motorist coverage. This section explores the state minimum requirements, average annual rates for each state, the difference between personal injury protection and medical payments, and coverage limits.

State Minimum Requirements for Auto Insurance

Every state has minimum requirements for auto insurance, which is essentially liability coverage. Liability coverage insurance is composed of two factors: bodily injury liability and property damage liability. These two factors are bundled together to provide policyholders with a coverage limit.

An example of a coverage limit would be $25,000 for bodily injury of one person per accident, $50,000 for bodily injury of multiple people per accident, and $25,000 for property damage per accident. The details of coverage limits are known as coverage rules and are abbreviated by the amount covered in the coverage limit. For the sake of the example, that would be 25/50/25.

The data presented below is a summary from the Insurance Information Institute that lists the state minimum requirements for each state.

Minimum Auto Insurance Liability Requirements by State
StateCoverage TypesCoverage Limits
ALBI & PD Liab25/50/25
AKBI & PD Liab50/100/25
AZBI & PD Liab15/30/10
ARBI & PD Liab, PIP25/50/25
CABI & PD Liab15/30/5
COBI & PD Liab25/50/15
CTBI & PD Liab, UM, UIM25/50/20
DEBI & PD Liab, PIP25/50/10
DCBI & PD Liab, UM25/50/10
FLPD Liab, PIP10/20/10
GABI & PD Liab25/50/25
HIBI & PD Liab, PIP20/40/10
IDBI & PD Liab25/50/15
ILBI & PD Liab, UM, UIM25/50/20
INBI & PD Liab25/50/25
IABI & PD Liab20/40/15
KSBI & PD Liab, PIP25/50/25
KYBI & PD Liab, PIP, UM, UIM25/50/25
LABI & PD Liab15/30/25
MEBI & PD Liab, UM, UIM, Medpay50/100/25
MDBI & PD Liab, PIP, UM, UIM30/60/15
MABI & PD Liab, PIP20/40/5
MIBI & PD Liab, PIP20/40/10
MNBI & PD Liab, PIP, UM, UIM30/60/10
MSBI & PD Liab25/50/25
MOBI & PD Liab, UM25/50/25
MTBI & PD Liab25/50/20
NEBI & PD Liab, UM, UIM25/50/25
NVBI & PD Liab25/50/20
NHFR only25/50/25
NJBI & PD Liab, PIP, UM, UIM15/30/5
NMBI & PD Liab25/50/10
NYBI & PD Liab, PIP, UM, UIM25/50/10
NCBI & PD Liab, UM, UIM30/60/25
NDBI & PD Liab, PIP, UM, UIM25/50/25
OHBI & PD Liab25/50/25
OKBI & PD Liab25/50/25
ORBI & PD Liab, PIP, UM, UIM25/50/20
PABI & PD Liab, PIP15/30/5
RIBI & PD Liab25/50/25
SCBI & PD Liab, UM, UIM25/50/25
SDBI & PD Liab, UM, UIM25/50/25
TNBI & PD Liab25/50/15
TXBI & PD Liab, PIP30/60/25
UTBI & PD Liab, PIP25/65/15
VTBI & PD Liab, UM, UIM25/50/10
VABI & PD Liab, UM, UIM25/50/20
WABI & PD Liab25/50/10
WVBI & PD Liab, UM, UIM25/50/25
WIBI & PD Liab, UM, Medpay25/50/10
WYBI & PD Liab25/50/20
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These limits are the minimum, but auto insurance providers may suggest that policyholders get a higher coverage level in case the coverage limit is not enough to cover the total cost of damage and injuries.

When a policyholder is injured by a hit-and-run driver, uninsured and underinsured motorist coverage kicks in. Sometimes, the person involved in an accident, regardless of fault, is underinsured, which can make medical bills and other costs complicated for the no-fault driver. With underinsured motorist coverage, however, the policyholder can receive compensation for injuries. It’s the same principle with uninsured motorist coverage.

Let’s examine the uninsured percentage by state from the Insurance Information Institute.

Uninsured Motorists by State
RankStateUninsured Motorists
1Florida26.70%
2Mississippi23.70%
3New Mexico20.80%
4Michigan20.30%
5Tennessee20%
6Alabama18.40%
7Washington17.40%
8Indiana16.70%
9Arkansas16.60%
10D.C.15.60%
11Alaska15.40%
12California15.20%
13Rhode Island15.20%
14New Jersey14.90%
15Wisconsin14.30%
16Texas14.10%
17Missouri14%
18Illinois13.70%
19Colorado13.30%
20Louisiana13%
21Oregon12.70%
22Ohio12.40%
23Maryland12.40%
24Arizona12%
25Georgia12%
26Kentucky11.50%
27Minnesota11.50%
28Delaware11.40%
29Nevada10.60%
30Hawaii10.60%
31Oklahoma10.50%
32West Virginia10.10%
33Montana9.90%
34Virginia9.90%
35New Hampshire9.90%
36Connecticut9.40%
37South Carolina9.40%
38Iowa8.70%
39Utah8.20%
40Idaho8.20%
41Wyoming7.80%
42South Dakota7.70%
43Pennsylvania7.60%
44Kansas7.20%
45North Dakota6.80%
46Nebraska6.80%
47Vermont6.80%
48North Carolina6.50%
49Massachusetts6.20%
50New York6.10%
51Maine4.50%
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The summarized data targets uninsured motorists in each state and ranks them from worst to best. While all cars do have to have a certain amount of required auto insurance coverage, this doesn’t always happen in practice. Uninsured and underinsured motorist coverage can help with a complex event in which a health insurance company is hesitant about covering a health insurance claim.

Additional coverage provides an alternative when health insurance won’t cover your medical bills. Personal injury protection (PIP) and medical payments (Med Pay) help auto insurance policyholders pay for medical bills and other related costs.

Watch this video on PIP and Med Pay for more information.

PIP pays for lost wages, lawyer fees, child care, and other personal injuries that resulted from an auto accident. Med Pay pays strictly for medical bills such as X-rays.

Cost of Auto Insurance

If you’re concerned about your health insurance not covering your medical bills, you may want to enroll in full coverage auto insurance. It will cost more than the average liability coverage you need, but you’ll be totally covered. (If your car is totaled and you’re leasing a new one, you’ll want to find out if you need full coverage insurance to lease a car.)

How much is full coverage auto insurance? The cost of auto insurance varies by state. Here’s a summary of the average annual rate by each state.

Average Annual Auto Insurance Rates by State
StateAverage Annual Rates
Virginia$2,358
Hawaii$2,556
West Virginia$2,595
Massachusetts$2,679
Ohio$2,710
Maine$2,953
Idaho$2,979
Iowa$2,981
Washington$3,059
New Hampshire$3,152
Wyoming$3,200
Montana$3,221
Vermont$3,234
Kansas$3,280
Nebraska$3,284
Illinois$3,305
Missouri$3,329
North Carolina$3,393
Indiana$3,415
Alaska$3,422
New Mexico$3,464
Oregon$3,468
Alabama$3,567
Wisconsin$3,606
Utah$3,612
Tennessee$3,661
Median$3,661
Mississippi$3,665
California$3,689
Arizona$3,771
South Carolina$3,781
Colorado$3,876
South Dakota$3,982
Pennsylvania$4,035
Texas$4,043
Arkansas$4,125
Oklahoma$4,142
North Dakota$4,166
New York$4,290
Minnesota$4,403
District of Columbia$4,439
Maryland$4,583
Connecticut$4,619
Florida$4,680
Nevada$4,862
Georgia$4,967
Rhode Island$5,003
Kentucky$5,195
New Jersey$5,515
Louisiana$5,711
Delaware$5,986
Michigan$10,499
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Factors that determine your auto insurance rates include age, gender, marital status, credit history, commute mileage, driving record, coverage level, and area. Each city, county, and town has a unique annual rate. Urban areas tend to have more expensive rates due to the increased risk of an accident, but rural areas generally have cheaper rates.

Take a moment right now to compare your auto insurance rates. Saving money for future needs is something everyone should do.

Make sure you have the right coverage to protect you from medical bills in an accident. Start by entering your ZIP code below and get fast, free, money-saving auto insurance quotes.

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