Insurance question

I know none of you are my lawyers etc,

If one is involved in an auto accident and brought to the hospital due to injuries.A bill then arrives from a 3rd party for services rendered to you at the hospital. Your auto insurance pay them less then the bill due to a contractual allowance is the 3rd party biller now allowed to ask you for the difference between the full bill and what they received?

IANAL, nor an insurance expert. I’ve just had people drive into my car for no apparent reason several times, and also had a person pull out in front of me when she had a stop sign. The following is based on those experiences.

NJ is a “no fault” state. Your own auto insurance pays all bills as submitted minus whatever deductible you have chosen. Period. If the insurance co believes the injuries were someone else’s fault they may go after that person and his/her insurance company for the total amount paid. If they are successful, you may get some or all of your deductible returned to you. This is called “abrogation.”

If the injury is sufficiently severe – for example, if you have broken bones – you can also make a claim against the responsible party for pain and suffering. Note that bruises and whiplash, although they can be extremely painful and cause suffering, are usually insufficient for such a claim. At least that’s what the lawyers told me.

I’m in Texas, we’ve had the same thing happen to us on several occasions. Sure, they are allowed to ask, and you’re allowed to tell them they’ve been paid their CONTRACTED amount, or contact your insurer.
I think they assume that a lot of people will just pay the difference, not knowing that they are not obligated to do so.


Are you talking auto insurance or health? I’ve never heard of an auto insurance company that had contracted rates with a medical provider. I haven’t been in the auto insurance industry since 01, but I’d find it hard to believe things have changed that much.

/hijack/ If you are driving a ridiculously expensive car (vintage restored, movie model, etc) or say, a beat up truck that happens to have valuable merchandise in it and someone hits you, what happens if their insurance doesn’t cover the full cost of your loss? On the one hand, they should be liable for reasonable damages, but on the other hand, it’s not really fair for some small mistake to end up making someone liable for a ridiculous amount of damages when you are the one putting an expensive fragile thing into a potentially dangerous situation.

jackdavinci your argument doesn’t hold water. Using your logic, why should I have to pay to repair your Mercedes, when if you had been driving a KIA, it would have cost my insurance company just 1/2 as much to repair. :rolleyes:

For that matter if you had been driving a '82 Chrysler K car, I could have just given you $5 and we could have call it even.

My lawyer would beg to differ with you. Look at it this way – if you are in a store and knock over a diamond-studded crystal vase worth a million bucks, you owe a million bucks for what you broke. OTOH if you knock over a $1.00 glass, you owe $1.00. Same thing with cars or their occupants that you damage. You total a brand-new Mercedes, you pay for a brand-new Mercedes.

It depends. You need to check the state laws regarding PIP protection. What kind of ‘contract’? Did the provider have a contract or does the insurance company come up with their own max allowables based on whatever they feel like? If there is no contract between the insurance company and the provider or state maximum charges (such as in Florida we have a cap at 2X medicare allowable) then you’re on the hook for the balance.

Apparently there is a max fee schedule where you can check.

It looks like the New Jersey system allows coordination between PIP and health coverage. The purchaser of the policy can elect to make his health coverage primary (just like it sounds–if the health policy covers it, the health coverage must pay whatever the policy requires before the PIP kicks in) or secondary (only covers excess over PIP coverage). As Foxy40 notes, caps on medical costs covered by PIP are administratively imposed. The rule also mentions deductibles. In other words, it appears you are liable for the difference.

ETA: If you have health insurance, make sure the medical bills for the excess get submitted to every insurer that provides health coverage for you.