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Are Insurance Carriers Required to Pay Medical Bills?

Insurance carriers are not required to pay for your medical bills automatically. Let's see how this works:

There is nothing in Texas law requiring an car insurance provider to pay for your medical bills after a car accident. If you've been injured in a car accident that was caused by another driver's negligent operation of their vehicle, you may be wondering how you will be compensated for your injuries.

After all, you've got hospital bills, prescription drug costs, and future treatments that must be paid. Even if your personal medical insurance covered some of the costs, you're going to be out of pocket a lot of money. You'd think that at least the other driver's insurance would be obligated to pay those costs, to say nothing of your PIP and/or your UIM/UM insurance. But that's simply not the case.

Questions Answered on This Page:

  • Is an insurance carrier required to pay for my medical bills?
  • How do I make sure my medical expenses are covered after a car accident?
  • Why do I need a lawyer to make sure my medical bills are covered?

The justification.

We get this question all the time: Why AREN'T insurance companies required by law to pay my claims? Here's some of the reasons why:

  • Due process: The defendant's insurance carrier agreed to be the other driver's financial bullet-proof vest in the event that he hurt someone and was sued. They did not agree to roll over and pay anyone who makes any allegation against their insured. Think of it this way. Even if we know for darn certain that someone has committed a murder, we don't immediately put them in prison. The laws of this country require that the accuser prove their case against the accused, and until this has happened, the matter is unresolved. Once the accused admits that he is guilty or if he is found guilty by a jury, then they are finally punished. In the exact same fashion, no matter how certain you are the other driver caused your injuries, they are not required to actually pay for their mistakes until their either voluntarily agree to do so or are found negligent by a jury. This concept of "you have to prove your allegations against the person who did you harm" is called "due process." The way insurance carriers see it, why would they pay you if there is a chance that their insured driver could be found not to be negligent? Sure, sometimes insurance carriers will read the writing on the wall and assume that their own client's liability is a foregone conclusion, but why would they do so, typically? Such a decision is at odds with their financial interests.
  • Claimants aren't always in the right: Just because you were in an accident doesn't mean it was the other driver's fault. Liability insurance is to help the victim, not the cause, of accidents. Occasionally, "victims" aren't victims at all but are seeking to defraud the system.
  • Reasonable people can disagree over your claim's value: Even assuming the other driver is at fault, you're only permitted to pursue losses directly attributable to the accident itself. Which injuries are "preexisting" and which are new can be open to debate in some cases.
  • The insurance companies' legislative lobby: Every year that the Texas Legislature is in session, you know that insurance lobbyists are crawling all over the Capitol. They want little "goodies" inserted into bills that benefit them, as well as any real penalties for failure to pay claims kept out.

The bottom line, too: they'll use every one of these tools to keep from paying you what you deserve. An experienced car accident attorney knows how to combat these tactics and put you in the best possible position to recover your losses.

How an attorney can force an insurance carrier to pay you what you deserve.

As the injured party, your attorney will have to prove the defendant's liability first. In other words, the other driver's insurance company is only required to pay after you prove to a jury that their client was responsible for causing your accident. Second, the burden is on your attorney to prove the full extent of exactly how you're injured. Briefly:

  1. Liability: Even if the police faulted the other driver, that's not the end of the story. Police aren't judges and juries, and they're sometimes wrong. Your lawyer needs to find the witnesses and evidence necessary for your case to win. Only when he's done that will the defendant insurance company entertain the idea of cutting a check for your injuries.
  2. Damages: But as in any tort case, it's not enough to show that the other driver did something wrong---you have to show, with medical certainty, that you're injured and those injuries came from the accident.

A further wrinkle: sometimes, an insurance company will accept liability for an accident victim's property damages but will deny liability for their medical injuries. Although many reasons could be sited for this practice, it usually comes down to economics. That is, property damages are usually much more definite and are often less costly than medical bills.

Here's why you should think about calling Grossman Law Offices.

Ensuring that you take the steps necessary to make the defendant's car insurance pay for your medical bills is extremely important to your long term health and quality of life. To best ensure that you can obtain compensation for your injuries, you should consult an experienced car accident lawyer Our attorneys invite you to give them a call any time, day or night, for a free consultation regarding how they may be able help you recover compensation for your injuries at (855) 326-0000.

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