Treating With Your Current Doctor After an Accident — A Cautionary Tale

Following an accident or injury, can you continue treating with your current doctor in lieu of a physician recommended by your lawyer? Of course the answer is yes. But, it may not be in your best interest to do so.

To illustrate, let us say you are an accident victim who was already being treated by a spine specialist for spinal issues predating the accident, which were then made worse by a car crash. Ideally, you would continue treating with your current doctor, who you certainly feel is in the best position to assess your new injuries and render appropriate care.

However, is this doctor, who was previously treating you through your health insurance, willing to pivot and begin treating you through the first-party medical benefits available on your car insurance policy?

The Role Car Insurance Plays in Treating With Your Current Doctor

That brings us to the issue of car insurance. When an accident occurs, you are forced to use it. Plain and simple. This is because the medical benefits on your automobile policy are primary to the medical benefits available through your health insurance plan in most cases.

So what happens when you have a doctor who doesn’t understand the nuts and bolts of administering medical treatment in accordance with the terms and conditions of your automobile policy, or is simply unwilling to deal with the extra red tape involved in working with the automobile carrier? That doctor, who you once held in high regard, will likely either refuse to provide the treatment they recommended to you when the auto insurance company fails to authorize it, or the doctor may simply opt to have their billing department submit the treatment to your health insurance company without going through the necessary steps to appeal the car insurance company’s self-serving and frivolous attempt to save money on a claim by denying medically necessary treatment.

In other words, your doctor will let the insurance company hamper your treatment or will let the insurance company off the hook completely AT YOUR EXPENSE.

What is disturbing about the latter possibility is that your lawyer is usually unaware that this doctor is not following the proper protocol (i.e. appealing the car insurer’s denial) until it is too late and is powerless to stop this doctor from taking the easy way out by seeking approval through your health insurance. This happens all the time, as most doctors realistically only concern themselves with rendering appropriate care and being paid for their services without anticipating the adverse economic impact their actions will have upon your case.

The Right of Subrogation in Treating with Your Current Doctor After an Accident

In short, many health insurance policies, as well as Medicare and Medicaid, have what is called a right of subrogation against the proceeds of your injury case. This means that your health insurance company may be entitled to repayment for any treatment paid for by them once they become aware of a third-party settlement (settlement between the at-fault driver and the victim), consistent with the notion that the responsibility for the cost of your accident-related treatment should be borne by the person who caused the injuries (i.e. the at-fault driver’s insurance company) and not your own health insurance. As such, your health insurance company may have a lien against your case that will be due at the time of settlement, representing the amount they paid for any accident-related care that was rendered to you from the date of your accident. This lien obligation SHOULD be compensable as an element of your damages against the at-fault driver’s insurance company.

However, with the wrong doctor in place, it very well may be coming out of your own pocket. This is because, pursuant to New Jersey law, a car crash victim’s ability to make the at-fault driver responsible for the amount of any health care lien (along with any other unpaid medical bills) hinges upon the exhaustion of all first-party medical benefits available from the victim’s car insurance policy.

In other words, if your doctor doesn’t fight the primary insurance company (i.e. your car insurance carrier) but rather targets your health insurance for easy payment, you are left vulnerable to a situation where you CANNOT seek recovery of the amount you must pay back to your health insurance company. As such, it is absolutely critical that your health insurance company does not make primary payment for your accident-related treatment until you have exhausted your car insurance benefits, and so YOU MUST have a doctor that is willing to fight the car insurance company on your behalf.

How Bross & Frankel Can Help

The personal injury attorneys at Bross & Frankel, P.A. spend countless hours forging relationships with doctors, who not only render exceptional medical care but also show a willingness to be an advocate for their patients. In helping you decide which doctors will treat you for your injuries, our practice only recommends the most trusted medical providers who are willing to fight for their patients and hold the car insurance carrier’s accountable.

The law firm of Bross & Frankel represents accident victims throughout New Jersey who have been injured in car accidents and other types of accidents. We handle all personal injury cases on a contingency fee basis, which means you won’t pay a fee unless we recover money for you. To learn more or to schedule a free consultation with a New Jersey personal injury lawyer, contact us today at (856) 795–8880 or fill out our online contact form.

About the Author: Alex Taylor

Alexander Taylor primarily assists with the firm’s Personal Injury and Social Security Disability matters.

Mr. Taylor is an experienced litigator with unparalleled dedication to client service. As a third-generation trial attorney, his passion and aggressiveness on behalf of his clients pay tribute to a family tradition of excellence. Alex utilizes his extensive and deep knowledge of personal injury, insurance regulations, and functions of the human body to make certain that no stone is left unturned, and that every client receives the benefits and compensation they deserve.

Alex focuses his practice on representing those who are injured as a result of someone else’s fault and he has a reputation with insurance companies, as well as adversaries, of relentlessly fighting for the rights of his clients. Having successfully handled hundreds of cases — from inception through resolution — his legal experience includes jury trials, arbitrations, mediations, depositions, as well as various other court proceedings.