No Insurance to Pay for Motor Vehicle Accident-related Medical Care

There are many reasons people do not have health insurance despite the federal mandate that everyone is required to have health insurance. Most people that do not have health insurance don’t have coverage because they cannot afford it or because a financial crisis has occurred and they didn't make the required premium payment and so were terminated by the health care program.

People don't have personal injury protection coverage on their automobile insurance policy for many reasons too. The most frequent reason is that they waived their right to that benefit. The law requires that any waiver of those benefits must be in writing. Often, we are told by the client’s insurance company that the client waived personal injury protection coverage. We demand that the insurance company provide us with a copy of the client signed waiver. Some clients who had to sign the waiver have forgotten that they waived their right to personal injury protection. The owner/driver of the vehicle may have waived coverage just for himself but not for the passengers. Even though personal injury protection has been in place under the client’s insurance coverage, there are a number of instances where coverage will not apply. On the application for personal injury protection benefits, there is a question that asks if anyone residing in the client’s household does not have personal injury protection coverage on their automobile policy and, if someone does not, that could result in a denial of benefits to our client.

Often individuals think that personal injury protection only covers the driver and any passengers in a vehicle. However, if an individual is injured by being hit by a vehicle (perhaps as a pedestrian), the injured person may obtain personal injury protection benefits.

The simplest way of dealing with this overwhelming issue of having neither personal injury protection coverage or some form of health insurance is for both the client and his attorney to sign a form called an “assignment of benefits”. The assignment of benefits document states that if, as, and when the case is settled, both the attorney and the client must pay the physician for the services that were rendered.

The assignment of benefits requires the client to agree to pay the doctor even if the client does not prevail in the case. Lawyers who represent clients on a contingency basis typically want to represent individuals who are likely to prevail in their claim. On the assumption that the case has merit, the risk to the client is not as great as one might think. Also, the charges by medical facilities, including physicians, are often at a higher charge than most insurance companies will pay. Therefore, before we settle the case or if a judgment is obtained from the court, we request that medical facilities and physicians reduce their charges. There is a well-recognized practice that lawyers who represent a client in a personal injury case may receive a reduction of one third of the medical charges. This practice does not apply to health insurance that is part of ESOP health insurance programs. Under ESOP health insurance programs, the administrators are precluded from reducing their charges. Please understand however that, in some instances, physicians still have the right to not provide all medical services and have the right to terminate medical services.

If clients understood that the cost of personal injury protection coverage may be as low as $10 every three months and understood the scope of personal injury protection, clients may not want to waive that coverage. State Farm, for example, provides personal injury protection at the Maryland minimum of $2500, but also at limits of $5,000, $7,500 and $10,000. Personal injury protection covers more than medical expenses and here are a number of examples of the scope of personal injury protection. Certainly the payment of medical expenses is most important but this insurance covers also lost income (sometimes called lost wages), and pays additional benefits such as housekeeping services, babysitters, funeral expenses and other services where the injured client is unable to provide the service himself. The treating physician must document the fact that it is reasonable and necessary for these services to be provided because the injuries caused by the accident resulted in the client being unable to perform those services.

This is why an experienced attorney can assist you in navigating through what may be a difficult process.

Fred Antenberg is an attorney with over 30 years’ experience assisting clients to obtain medical benefits through an assignment of benefits. Fred also is familiar with those physicians who will accept an assignment of benefits when the client neither has health insurance or personal injury protection. Call Fred Antenberg at 410-730-4404 for an appointment and for a free initial consultation.