Under California law, someone who wrongfully causes an accident or injury is responsible for the injured party’s medical bills. These bills may be paid directly by the person or company responsible, or by the liable party’s insurer.
Unfortunately, responsible parties don’t always pay up right away.
Sometimes they delay in order to make a low-ball out-of-court settlement more attractive. Or they force the injured party to file a lawsuit.
To get “medical bills” paid after a California accident or injury, an injured person will often need to look to:
- Private health insurance;
- Government health insurance such as Medicare, Medi-Cal or the Children’s Health Insurance Program (CHIP)
- California “Med Pay” auto insurance;
- California worker’s compensation, or
- A healthcare provider willing to work on a California “medical lien” basis.
To help you better understand how to get your medical bills paid after a California accident or injury, our California personal injury lawyers discuss the following, below:
- 1. Who pays?
- 2. I have no insurance
- 3. Doctor’s liens
- 4. Insurance discounts
- 5. More than one policy
- 6. Subrogation
- 7. Med Pay
- 8. Records and bills
- 9. Pre-existing injuries
- 10. Insufficient settlements
- Additional reading
1. Who pays?
When another party has breached a duty of care in California, that party is legally responsible for the injured party’s medical bills and other damages. However, responsible parties seldom admit liability or pay the bills right away.
People have several options for getting their medical bills paid while they are waiting for a case to go to trial or to settle.
Such options include private health insurance — such as insurance obtained through an employer or Covered California — or government insurance such as Medicare or Medi-Cal.
There may also be optional person insurance such as a California homeowner’s or renter’s policy or California Med-Pay insurance for vehicles.
Please see our article on how medical bills get paid after an accident.
Liable parties are legally responsible to pay for damages.
2. I have no insurance
California law requires hospitals to negotiate discounts and a reasonable payment plan with patients:
- Who are uninsured, or
- Whose family income does not exceed 350% of the federal poverty level.1
Other providers may be willing to work for a “medical lien” in California. If a doctor or other health care provider works on a lien basis, the provider will delay payment until you resolve your case.
Our California injury attorneys can refer you to a network of doctors, chiropractors and therapists who are willing to work on a lien. We may also be able to help you negotiate with doctors, therapists and hospitals to lower your bills or come up with a more manageable payment plan.
3. Doctor’s liens
It is generally preferable to use health insurance rather than getting a medical provider on a lien basis after an accident in California. Medical providers that provide services on a lien basis get repaid from the proceeds of any lawsuit or out-of-court settlement.
However the patient is ultimately responsible for bills that exceed the amount of any eventual recovery. Additionally, providers will usually bill at their full rate when they work on a lien.
If you use your insurance, however, the provider cannot legally charge you more than the contracted rate. This is often considerably more favorable, especially if you use an in-network provider.
Other advantages of private insurance include:
- For plan years beginning in 2014 and later, the Affordable Care Act prohibits a lifetime maximum or yearly cap on payouts; and2
- Injured people will usually also have more providers to choose from if they use their insurance.
For all these reasons, we usually recommend using insurance instead of paying a doctor on a lien unless:
- You do not have health insurance (either privately or through the government);
- You desire a provider or services not covered under such insurance (for instance, if your insurance does not cover chiropractic); or
- You are unable to afford your deductible and/or co-pays.
4. Insurance discounts
The other party’s lawyer and insurers will not “punish” someone for their health insurer’s discounted rate. Settlement offers are based on the full value of a doctor’s bills, regardless of how much a patient or insurance actually pays.
5. More than one policy
If you have good insurance coverage, you may have more than one policy that might cover your medical expenses after an injury or accident in California. There may be some situations in which you want to submit first to one type of insurance rather than another.
For instance, if you want both an orthopedist and a chiropractor and your health insurance doesn’t cover chiropractic. In such a case, you may want orthopedic bills to go to your health insurer while saving Med Pay (discussed below) for chiropractic.3
An experienced California injury lawyer can help you determine whether it makes sense to pick and choose. In general, however, you will usually want to submit your bills to ALL the insurance companies that might reimburse you.
6. Subrogation
Private and government health insurers usually have what is known as a “subrogation right.” This means they have the right to be reimbursed from the proceeds of any lawsuit or out-of-court settlement.4
This right applies only if you actually get money from the wrongful party. In some cases, your insurer may have the right to “step into your shoes” and sue on your behalf.
Although this may seem convenient, your insurer’s goals are probably different than yours. You may still want to hire your own attorney to look out for your interests, not just those of your insurer.
You are advised to carry Med Pay if possible.
7. Med Pay
Some people carry optional auto insurance known as medical payments coverage — or California “Med Pay” for short. To get med pay, you must elect it and pay a separate premium for it.
With Med Pay, your auto insurer is obligated to cover your medical expenses regardless of fault up to the limit you have selected – usually $1,000, $2,000, $5,000 or $10,000 per person.
Med Pay can be desirable for several reasons, including:
- No deductible on medical payments;
- The insurer must pay even if you were at fault;
- Covers practitioners (such as chiropractors and acupuncturists) that may not be covered under your health insurance;
- Covers passengers in your vehicle;
- Applies even when you are a pedestrian or a passenger in someone else’s vehicle and
- Payments cannot be used to reimburse your health insurer.5
The short answer is that if you have Med Pay you should generally use it and let your auto insurer and your health insurer work out who pays what.
8. Records and bills
The other party’s insurer will need copies of your bills. Your doctor or primary provider will also need to provide a diagnosis as well as a copy of test results such as x-rays or MRIs.
Your doctor or therapist should keep notes that tie the treatment you receive to the accident or injury. Additionally, the other insurer will probably request relevant medical records going back at least five years.
For instance, if you are claiming a neck injury in California, you would need to supply at least five years worth of records from primary care doctors, chiropractors, orthopedic doctors, and any other providers that treated you for similar injuries.
You do not need to provide unrelated records (such as those from colorectal surgeons or gynecologists) unless your injuries affect those areas.
You also do not need to provide records of substance abuse, psychological counseling and similar services unless you are claiming damages for:
- anxiety,
- insomnia,
- emotional distress,
- pain and suffering or
- similar, non-physical harm.
Other info that will help speed up payment of medical bills includes (but is not limited to):
- Names and contact info of all parties and witnesses to the accident;
- Your insurance company’s report(s) and any police accident report;
- Photos of your injuries (if visible); and
- Photos and/or videos of the accident scene, vehicles, defective product, etc. and
- Anything else that might be helpful, including statements of witnesses, co-workers, friends, or family members talking about the accident has affected you.
You can recover damages if an accident aggravated a pre-existing injury.
9. Pre-existing injuries
Pre-existing injuries make it difficult (though not impossible) to recover damages after an accident.
If your pre-existing injury was made worse by the accident, you are still entitled to recover.6
Example: Dan is an emergency medical technician (EMT). Two years ago, he threw his back out moving a heavy patient on a gurney. He still has to go to the chiropractor once in a while when his back really starts hurting.
As Dan is coming home from a movie one night, he is rear-ended by a drunk driver. His back goes out again and he has to miss six weeks of work. Even though Dan’s already had a bad back, because the accident made it worse, the other driver (or his insurance) is responsible for Dan’s medical bills as well as his lost wages from missed work.
10. Insufficient settlements
The other party’s insurer may offer a settlement that is not large enough to pay your bills. You may be tempted to take the offer on the theory that something is better than nothing.
An experienced California personal injury attorney can help you evaluate the strength of your case and assess your bargaining position. A good attorney can often negotiate a larger settlement and/or convince your medical providers to reduce their bills.
What is ultimately important is not the total amount of your settlement but how much of it ends up in your pocket. Our goal is to let you keep as much as possible so that your bills are covered and you are compensated for your pain and suffering.
Additional reading
For more in-depth information, refer to these scholarly articles:
- To Protect You From the Medical Bills That Can Ruin You – Silberg v. California Life Insurance Company – University of San Fernando Valley Law. Review.
- Surprise Medical Bills: How to Protect Patients and Make Care More Affordable – Georgetown Law Review.
- The Concept of Reasonable Value in Recovery of Medical Expenses in Personal Injury Torts: An Update from 2008 to 2015 – Journal of Legal Economics.
- The Financial Impact of Automobile Accidents – University of Pennsylvania Law Review.
- Drive-by-Doctoring: Contractual Issues and Regulatory Solutions to Increase Patient Protection from Surprise Medical Bills – American Journal of Law & Medicine.
Legal references:
- California Health and Safety Code Sections 127400 – 127446 — Hospital Fair Pricing Policies.
- 42 U.S. Code § 300gg–11.
- See, for example, Nager v. Allstate Ins. Co. (2000) 83 Cal.App.4th 284, 290.
- See, for example, Griffin v. Calistro (, 1991) .
- See note 3.
- See, for example, Sumpter v. Matteson (Cal.App. ) .