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If you are in a car wreck, it is nearly impossible to predict how your body will react. More often than not, however, the wreck will cause some type of bodily injury. It is simply the nature of two large objects colliding.
Injuries such as broken bones and lacerations (cuts) are usually readily apparent and can be easily treated through traditional medical avenues. These types of injuries are easier to diagnose and treat for medical providers because they are typically visible on an x-ray or an MRI. The treatment course for these types of injuries is also well known and has been perfected over the years. Typically, these types of injuries will be treated through an emergency room, an orthopedic physician, and/or physical therapists.
More common injuries for car wrecks are what are called “soft tissue” injuries. These are injuries where ligaments and muscles stretch. Soft tissue injuries can include whiplash and back injuries. Soft tissue injuries are difficult to diagnosis at the emergency room or at urgent care for two reasons. First, these types of injuries often do not manifest themselves until many days (and sometimes weeks) after the crash. Second, these types of injuries are rarely visible through imagining studies (e.g. x-ray or MRI). Consequently, they are often not immediately detected by medical professionals.
These injuries can result in significant amounts of pain even though the injury itself is not readily apparent on an x-ray or an MRI. The stretching of muscle and ligaments can result in extended healing time (often longer than a broken bone). To make matters worse, more traditional medical avenues such as surgery, pain killers, etc. provide very little to no relief for these types of injuries. Commonly, these injuries are treated through chiropractic care, acupuncture, yoga, exercise, and other less traditional medical avenues. Because there is no “magic” pill or surgery to heal the patient, these methods can often take months before the patient begins to see relief.
Another significant category of injuries that are common place with a car wreck are disc herniation, slip discs, and other acute types of back injuries. Like soft tissue injuries, these injuries can go undiagnosed for many months because the source of the pain may not always be readily apparent. Unlike a more common soft tissue injury, however, disc injuries may be visible on an MRI (although not an x-ray). Due to the costs of an MRI, however, this imagining is not always performed after a car wreck. Consequently, it can take months (and sometimes years) before an MRI is performed to determine that the source of a person’s pain is from a disc injury. Further, most health plans and physicians prefer to attempt conservative care (such as chiropractic) to rule out a less serious soft tissue injury before incurring the expense of an MRI. As anyone with back injuries knows, disc issues can be very painful and debilitating. If you do have a disc injury, there are several avenues for relief. Initially, conservative care, e.g., through a chiropractor, can be of some benefit. For more serious disc issues, a back surgeon may be necessary.
Unlike many other states, New Mexico is not a “no-fault” state. This means that if you are injured, you must prove that the other driver caused your injuries before you are entitled to any compensation even for your medical expenses. Contrary to popular belief, even if you are not at fault for a car accident, you are responsible to pay for your medical care. Although the cost of this treatment may later be a category of damages in your claim/lawsuit against the negligent party, it is up to you to immediately pay for that medical care.
If you do receive benefits from an insurer or medical provider that directly resulted from the injury-causing wreck, then you may have to repay a portion of those benefits. This is known as subrogation. The rights of the medical provider and/or insurer are usually contained in the contact you signed with that entity, the insurance policy, through statutes, and can be found in common law. If you receive any money from a third-party or your own insurance carrier as a result of a car accident, then you may be required to repay your medical providers and/or insurer. As discussed below, the amount you have to repay can vary dramatically depending on how you pay for medical services. In other words, how you pay for medical care can affect how much money you get in “your pocket” after a settlement or judgment.
The first line of defense if you have been injured in a car wreck is your health insurance. Health insurance is there for you whenever you have been injured. Often, injured people believe that they should not use their health insurance after a car accident. It is a mistake, however, not to utilize your own health insurance after any car accident.
The primary benefit of using your health insurance is that you are able to take advantage of the contract your health insurance carrier negotiated with your medical provider. To accept patients from your health insurer, your medical provider agreed to accept a reduce rate for his or her services. For example, your primary care physician may charge $120 for each office visit if you do not have health insurance. Your health insurer, however, will only pay that physician $60 for each office visit plus your co-pay. The amount you will have to repay to your health insurer is only $60 (less any reduction under the common fund doctrine or any other equitable remedies discussed more fully below) and not the full $120. If you just went to the physician without health insurance, you have to repay the full $120 rather than $60.
Medical payments (a/k/a “med pay”) coverage is a “no-fault” coverage you can purchase from your automobile insurer carrier. Similar to health insurance, med pay will pay your health providers immediately and without regard for who may be at fault. It can also pay for any co-pays and other types of medical expenses that are not covered by health insurance. If you do not have health insurance, this is a very good insurance to purchase in additional to liability and uninsured/under-insured motorist protection.
Medical payments coverage is not without its problems. Like health insurance, medical payments coverage must be repaid if you obtain any money for your injuries from either the tortfeasor (the negligent driver) or you own UM/UIM coverage. Unlike health insurance, however, most (not all) med pay providers do not have a negotiated contract with medical providers. That means, using our example above, that med pay will pay your primary care physician $120 for his services. You then have to repay med pay (less any reduction discussed below) the full $120 rather than the $60 discussed above.
To complicate matters, med pay is considered to be a “primary payor”. This means that if you have health insurance or Medicare/Medicaid, then technically your medical provider is to bill med pay first and bill your health insurer/Medicare/Medicaid second. This can result in paying the full amount of a physician’s/hospital’s bill without the benefit of the negotiated contract.
The Davis Kelin Law Firm is Albuquerque’s Premier Personal Injury Law Firm. Contact us today about your case at (505) 242-7200.
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