Who Pays My Medical Bills After a Car Accident in Pennsylvania?
Most people assume that the driver who caused the crash pays their medical bills, and that the payment starts arriving shortly after the accident. Pennsylvania does not work that way. The bills usually start with the injured person's own insurance policy, and the amount that policy covers is often far less than the cost of the treatment.
Understanding the order in which those bills get paid matters, because it determines how much of the cost an injured person is left carrying and whether a claim against the at-fault driver is even available.
Your Own Insurance Pays First, Regardless of Fault
Pennsylvania is what is known as a choice no-fault state. Every registered vehicle in the Commonwealth must carry first-party medical benefits coverage, and that coverage pays for accident-related treatment no matter which driver caused the crash.
The minimum amount of first-party medical benefits required by Pennsylvania law is $5,000. That is the floor, and a great many drivers carry exactly that floor without realizing it. An emergency room visit, diagnostic imaging, and a short course of physical therapy can consume $5,000 well before treatment is finished. A broken bone or an overnight hospital stay can exhaust it in a single day.
Drivers can purchase higher limits, and many insurers offer coverage at $10,000, $25,000, $50,000, or $100,000. Anyone reviewing their policy after reading this would be well served to check which tier they actually selected.
What Happens After the Medical Benefits Are Exhausted
Once first-party medical benefits are used up, the remaining bills generally shift to the injured person's health insurance, subject to whatever deductibles and copays that plan carries. If there is no health insurance, the bills fall to the injured person directly while the claim is pending.
Recovering those costs from the driver who caused the crash is a separate process, and it depends on that driver's liability coverage. Pennsylvania's minimum liability limits are $15,000 per injured person and $30,000 per accident for bodily injury, plus $5,000 for property damage. Those minimums are among the lowest in the country, and a serious injury can exceed them quickly.
Full Tort and Limited Tort: The Election That Changes What Can Be Recovered
When a Pennsylvania driver buys auto insurance, that driver must choose between two options under 75 Pa.C.S. Section 1705. The choice is often made quickly, based on the premium difference, and most people do not revisit it until they are hurt.
Under the full tort option, an injured driver keeps the unrestricted right to seek compensation from the at-fault driver. That includes economic losses such as medical bills and lost wages, and it also includes non-economic losses such as pain and suffering.
Under the limited tort option, the premium is lower, and the injured driver still remains eligible to recover economic losses such as medical bills and lost income. What limited tort restricts is the ability to recover for pain and suffering and other non-economic damages. That restriction applies unless the injury meets the statutory definition of a serious injury, or unless one of several exceptions applies.
It is worth noting that a driver who never returns a signed election form is treated as having chosen full tort. A driver who owns a registered vehicle without maintaining the required insurance, however, is treated as having chosen limited tort.
Limited Tort Does Not Automatically Mean There Is No Claim
This is the point where a great many Pennsylvania drivers give up on a claim they may still have. An insurance adjuster tells them their policy is limited tort, and they conclude that nothing further is available to them.
The statute itself sets out specific circumstances in which the limited tort restriction does not apply, and an injured person may pursue non-economic damages as though full tort had been selected. Those circumstances include the following:
The at-fault driver was convicted of driving under the influence, or accepted Accelerated Rehabilitative Disposition for a DUI arising from the crash.
The at-fault driver was operating a vehicle registered in a state other than Pennsylvania. What matters here is where the vehicle is registered, not where the driver happens to live.
The at-fault driver was operating without the financial responsibility that Pennsylvania law requires.
The at-fault driver intended to cause injury rather than causing it through negligence.
The injured person was occupying a vehicle other than a private passenger motor vehicle at the time. This matters more often than people expect in this part of the state, because it can cover someone hurt while riding in a work truck, a commercial vehicle, or a bus.
The claim is against a business that designed, manufactured, repaired, serviced, or maintained the vehicle, and the injury arose from a defect connected to that work.
Separately from those exceptions, an injured person who sustains what the statute defines as a serious injury may pursue non-economic damages regardless of the limited tort election. Whether a particular injury meets that threshold is a fact-specific question, and it is one that insurance companies routinely dispute. Thorough medical documentation matters considerably in those cases.
None of this means that any given claim will succeed. It means that a limited tort election, standing alone, is not a reliable answer to whether a claim exists. That question requires someone to look at the specific facts.
How Long Is There to File a Personal Injury Claim in Pennsylvania?
Pennsylvania generally allows two years from the date of the injury to file a personal injury lawsuit. Certain situations change that timeline, including claims involving minors and claims against government entities, which carry their own notice requirements.
Waiting until the deadline approaches creates real problems well before it arrives, because evidence becomes harder to gather, vehicles are repaired or scrapped, and witness recollections fade. The practical deadline is almost always earlier than the legal one.
A Note About Speaking With the Insurance Company
Adjusters frequently contact injured people within days of a crash, often before the full extent of an injury is known. Recorded statements given at that stage can be difficult to walk back later, particularly when symptoms develop or worsen in the weeks that follow.
There is no obligation to give a recorded statement to the other driver's insurer before speaking with a lawyer.
Talk It Through With Sutton & Lovette
Sutton & Lovette is based in Ebensburg and works with injured people throughout Central Pennsylvania and the surrounding communities.. Anyone who is unsure whether they have a claim, or who has been told by an adjuster that their coverage prevents one, call and ask.
Calls to the firm reach the firm directly rather than an answering service, and the firm returns calls as quickly as it can. The consultation is free, and there is no cost simply to find out where things stand. Call Sutton & Lovette at (814) 471-7702, today.
