A Car Hits You While You Are On A Club Ride – What you Need to Know About Medical Bills
You are on a Club ride and a car hits you. One thing is for sure: you will need to get medical treatment and to pay for it. That, and nothing else, is the subject of this article1. And although I am an attorney licensed in the State of New Jersey, this article is not intended as legal advice and should not be taken as such. My purpose in writing is to help you navigate the system intelligently by knowing who is supposed to pay what.
I write on the assumption that you are covered by a New Jersey auto insurance policy for a passenger vehicle2. If this is not so, this article is irrelevant to you.
First Important Fact: in New Jersey, your own auto insurer is primarily responsible for paying for your injuries from auto accidents. Your auto insurer. Not your medical/Medicare insurer. Not the “at fault” party’s insurer; New Jersey is a “no-fault” auto insurance state. Thus, if you are covered by a New Jersey auto insurance policy and you are injured in an auto accident, you should first look to your auto insurance carrier.
Second Important Fact: some New Jersey physicians will not treat auto accident victims. This is because those doctors do not accept the compensation set by the “Personal Injury Protection (PIP)” coverage that an auto accident victim gets from his or her auto insurance. (The New Jersey Department of Banking and Insurance promulgates a PIP fee schedule that specifies what a doctor gets paid for specified medical services rendered to a patient who has been in an auto accident. As you may imagine, this schedule is not particularly generous.) If you are making an appointment with a doctor to address post-auto accident medical care, make sure the office knows that an auto accident was the cause! If you accept treatment from that doctor and the doctor’s office has not made appropriate arrangements with your auto insurance carrier, the carrier may refuse to pay and you will be on the hook3.
Third Important Fact: your medical insurance carrier, or Medicare, is secondarily liable for paying what your auto carrier is not required to pay. If – as will usually be the case – you end up with a balance due even after your auto carrier has paid the appropriate amount to your doctor, you should submit that balance to your medical insurance carrier. When you do this, you will need to provide evidence of what your doctor did and charged for and what your auto insurance carrier paid the doctor. Your medical insurance carrier/Medicare will pay benefits in accordance with its contractual/statutory obligations to you.
On this issue, you need to know that some providers of medical services don’t play by these rules. In my case, I was taken to Morristown Hospital by an ambulance service, and you would think that an ambulance service would have the experience to know that it should bill my auto insurance carrier first. It didn’t. It billed my medical insurance carrier, which paid, and it then came after me to pay the unpaid balance of its charges. I told the service that it had made a mistake, and it ignored me. (I am used to this!) I got my auto insurance carrier involved, and the claims manager said this happens all the time. She took the matter on, and I have not heard further.
Fourth Important Fact: you are covered by the Club’s insurance policy! When you report your accident to the Club’s Safety Coordinator (currently Drew Thrain) he will provide you with a claim form. You provide the information they request and they process your claim.
Summary: in all likelihood, if you are unfortunate enough to be struck by a car while you are on a Club ride, you will be covered by three different insurance programs. Deal with them in the correct order – and get better!
Mark Jay (email@example.com)
- If you want to know about fixing/replacing your bike, getting compensation for your injuries, and getting compensation for wages you lost while you were out of work, talk to a lawyer. But not me. ↩︎
- If you are hit by a dune buggy or a motorcycle, PIP benefits do not apply. And special rules apply to pickup trucks, vans, panel trucks, etc. I don’t discuss these here. ↩︎
- If you are treated in a hospital, you won’t have this problem. All New Jersey hospitals accept PIP coverage. ↩︎