Does Health Insurance Cover Car Accident Injuries?

Car accidents can be traumatic event in one’s life, and can often lead to physical injuries, emotional distress, and financial difficulties. When you are involved in a car accident and you are injured, many begin thinking about medical expenses and how they will pay them off. We all pay for health insurance to alleviate the cost of these medical expenses. Let’s take a closer look at if health insurance covers car accident injuries with Mutrux Firm today! 

Understanding Health Insurance

Health insurance is a critical piece of insurance that everyone should have. Health insurance is a contract between an individual and an insurance company where the insurer agrees to pay for certain medical expenses in exchange for premiums paid by the insured. In most cases, these expenses are usually hospital stays, doctor visits, prescriptions, and preventative care. Depending on the plan, health insurance policies vary greatly when it comes to the terms of coverage, deductibles, co-pays, and network providers.

Types of Health Insurance

  1. Employer-Sponsored Insurance: Provided by employers as part of employee benefits packages.
  2. Individual Health Insurance: Purchased by individuals directly from insurance companies or through health insurance marketplaces.
  3. Government-Sponsored Insurance: Includes Medicare for seniors, Medicaid for low-income individuals, and other specialized programs like CHIP (Children’s Health Insurance Program).

The Role of Health Insurance in Car Accidents

When you get into a car accident, it’s important to take into account the well-being of everyone involved. It is important for everyone to get medical care, regardless of how severe their injuries might be. Therefore, health insurance plays a crucial role in covering these expenses, however, how much it covers depends on a few different factors.

Coverage Scenarios

  1. Immediate Medical Attention: Health insurance typically covers emergency medical care required immediately after a car accident. This includes ambulance services, emergency room visits, and urgent care.
  2. Ongoing Medical Treatment: If injuries require ongoing treatment, such as physical therapy, surgery, or specialist consultations, health insurance may cover these costs, subject to policy terms.
  3. Rehabilitation: Post-accident rehabilitation, including physical therapy and mental health services, can also be covered by health insurance plans.

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Coordination of Benefits: Health Insurance and Auto Insurance

Health insurance and auto insurance must work together to cover your expenses, and how these two play together is critical in deciding who pays for what. Let’s check out a few scenarios below: auto insurance types and primary vs. secondary insurance.

Auto Insurance Types

  1. Personal Injury Protection (PIP): Covers medical expenses regardless of who is at fault in an accident. PIP is mandatory in some states.
  2. Medical Payments (MedPay): Optional coverage that pays for medical expenses incurred by the insured and passengers.
  3. Liability Coverage: Pays for injuries and damages the policyholder causes to others if they are at fault.
  4. Uninsured/Underinsured Motorist Coverage: Provides protection if the at-fault driver lacks adequate insurance.

Primary vs. Secondary Insurance

In most cases, car accident injuries are paid for by your car accident policy. Health insurance is designed to act as the secondary payer, and covers the remaining expenses after the auto insurance benefits are depleted. However, it is important to note that this depends on state laws and the terms of your policy.

  1. Primary Payer: Typically, PIP or MedPay coverage from the auto insurance policy.
  2. Secondary Payer: Health insurance steps in to cover additional costs not covered by the primary payer.

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Legal and Practical Considerations

It can be difficult to navigate insurance claims after a car accident, as you must be familiar with state laws, insurance regulations, and the specifics of your policy. This is why it is crucial to get in touch with an attorney to help you throughout the process.

State Laws and No-Fault vs. At-Fault Systems

Each state operates on a different system, and are either no-fault or at-fault states.


States operate under different systems that affect insurance claims and coverage:

  1. No-Fault States: Require drivers to carry PIP insurance, which covers their own medical expenses regardless of fault. Health insurance may still play a role once PIP limits are reached.
  2. At-Fault States: The at-fault driver’s liability insurance is responsible for covering medical expenses. Health insurance may cover costs if the at-fault driver’s insurance is insufficient.

Missouri is an at-fault car accident state, meaning that drivers must carry a minimum amount of coverage on their insurance policy to cover liabiliy. 

Filing Claims

  1. Auto Insurance Claims: Initiate by contacting the auto insurance company, providing details of the accident, and submitting medical bills for reimbursement.
  2. Health Insurance Claims: Submit claims to health insurance after auto insurance coverage is utilized. This often requires detailed documentation of the accident and expenses.


When your insurance company goes after the at-fault driver for reimbursement on medical expenses, this is called subrogation. This helps the insurance company manage costs and prevent any double recovery from the insured.

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Case Studies

Case Study 1: Simple Collision with PIP Coverage

John, living in a no-fault state, was injured in a minor car accident. His PIP coverage paid for immediate medical expenses, including an ER visit and initial treatment. However, his injuries required ongoing physical therapy. Once his PIP limit was reached, John’s health insurance began covering the remaining therapy sessions.

Case Study 2: Severe Accident with At-Fault Driver

Sarah, in an at-fault state, was severely injured by a driver who ran a red light. The at-fault driver’s liability insurance covered Sarah’s immediate medical expenses. However, the policy limits were insufficient for her long-term rehabilitation needs. Sarah’s health insurance then covered the additional costs, and her insurer pursued subrogation against the at-fault driver’s insurance.

Challenges and Considerations

High Deductibles and Out-of-Pocket Costs

Health insurance plans that have high deductibles and significant out-of-pocket costs can leave accident victims with expenses that they might not be able to afford, even when insurance coverage is available. 

Policy Exclusions and Limitations

Depending on your health insurance coverage, there might be limitations or exclusions on coverage for your car accident, and require review of your policy terms and conditions.

Legal Assistance

In some cases, seeking legal assistance can help you navigate the claims process when accidents involving significant injuries or disputes between insurance companies occur. This will help ensure that you recover the compensation that you deserve for your injuries.

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Don’t Navigate the Legal Process Alone, Get in Touch With Mutrux Firm Today!

Health insurance is a crucial lifeline for many, especially when someone is involved in a car accident and has injuries. However, coverage depends on the type of insurance policies involved, state laws, and the specifics surrounding the accident. These can all be very overwhelming to deal with on their own, which is why it is important to get in touch with an attorney you trust to help you deal with the insurance company when things get difficult.

If you’ve been injured in a car accident, and find yourself overwhelmed when dealing with the insurance company and legal process, you can count on Mutrux Firm Injury Lawyers to help you out and get you the justice you deserve. Give us a call at  (888) 550-4026 or contact us here for more information. We’re dedicated to our clients and will be with you every step of the way.

Tyson Mutrux