Question: Who pays my medical bills with respect to a car accident? I was not at fault. It has been a few days after an accident. My back pain is getting worse. My car insurance plan says 5000/1250. If an accident was not my fault, why should my insurance have to pay? If I do run medical through my own coverage, does anyone know what this figure of 5000 (emergency)/1250 (non emergency) means? Also, the police did not give me a report, but a traffic exchange form. Is this the same thing?
Mike Hancock’s Answer: The 5000/1250 you refer to is actually your Medical Payments coverage on your policy. Your policy will also have 10000/2500 in Personal Injury Protection (PIP) benefits. The law just changed in January 2013 and now if you don’t seek medical treatment within 14 days of the accident, you lose your entitlement to all your PIP benefits. If you seek medical attention within 14 days and the doctors agree you had an emergency medical condition, you are entitled to your full 10000 in PIP benefits. If the doctors say you did not have an emergency medical condition, you may only be entitled 2500 in PIP benefits. The same applies to your Medical Payments benefits: 5000 if you have an emergency medical condition; and 1250 if no emergency medical condition. We are just now starting to see a few insurance companies start to limit PIP and Med Pay claims after they have hired their own doctors to do paper reviews of clients’ medical records and render an opinion that there was no emergency medical condition. Whether that will hold up in court has yet to be determined.
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