Do I Have To Use My Health Insurance for Injury Treatment?

Does an accident victim have to use his/her health insurance when treating for injuries?Whenever a new case comes across my desk, I am usually asked this question in one form or another.Last week, the California Court of Appeal touched on this issue in the very important case of Pebley v. Santa Clara Organics.Mr. Pebley was injured in 2011 in a truck collision. Eventually, he required spinal surgery for his serious injuries.  Mr. Pebley had health insurance through Kaiser, but he opted to treat with doctors and surgeons not affiliated with Kaiser.  These providers treated Mr. Pebley on a lien, which means they agreed not to receive payment for their services until Mr. Pebley's case settled.The truck insurance company argued that because Mr. Pebley had Kaiser, he should have had his treatment at Kaiser.  Alternatively, they argued that his outstanding medical bills should have been discounted at the same rate, and much the same as health insurance companies like Kaiser experience.The Court rejected these arguments.The Court provided a detailed analysis as to why an injured person would elect to treat with providers on lien instead of submitting the payment to health insurance.Health insurance can be very expensive, and many families make specific economic calculations when purchasing health insurance.  A traumatic accident that suddenly imposes months and months of expensive medical treatments on an individual can significantly alter these economic calculations.There are a whole host of other reasons why an injured person would choose not to treat with his/her health insurance.  Suffice to say, the defense routinely uses this to imply that there's something unKosher about this type of arrangement.  In Pebley, the Court rejected these improper arguments.The Court also ruled that when an injured plaintiff treats with providers outside of his or health plan, the plaintiff is regarded as uninsured for purposes of calculating damages.That means no reductions or discounts are made as they would be when health insurance is billed for treatment.  The standard, instead, is whether the uninsured plaintiff's bills are "reasonable and necessary."Pebley v. Santa Clara Organics is a groundbreaking case that will protect injured plaintiffs and enable them to get the care they need, irrespective of misleading defense arguments.For questions about your Los Angeles car accident injury case, the Rabbi Lawyer is ready to assist, 24.6.