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What Happens When Medical Bills Exceeds Settlement in SF?

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What Happens When Medical Bills Exceed Settlement?

Your vehicle accident settlement is going to be the only compensation you’re going to get after an injury accident, and you might want to pause and think:

  • What are my rights in this settlement claim?
  • At what point should I settle?


When the medical bills are 100 percent your responsibility, you want to make sure that the settlement for your personal injury covers the expenditure you will or have already faced. 

In this article, we’ll be exploring what happens when your medical expenses exceed the settled amount after an auto accident, when and why that happens, and how to avoid it from happening in the first place. 

Paying Your Medical Expenses After an Auto Accident

For most of us, the most significant financial crises come from unexpected medical costs. Even minor injuries can pile up vast and urgent bills. Every ride in an ambulance, emergency room visit, blood work, X-Rays, and MRIs, prescriptions, follow-up procedures, hospital stay, surgery, rehabilitative equipment, and any extended care can end up costing thousands of dollars. 

Paying for all of that can be a daunting task, even if you have enough savings, an insurance plan, or both. The insurance company’s payments are conditional and depend upon:

  • The length of the treatment
  • The insurance plan
  • Who was the at-fault party


An insurance company handles claims with the intention of either minimizing the costs or managing the risks. They’ll do everything to avoid going to court, which is a much more resource-intensive process; plus, the jury’s decisions are unpredictable. At the same time, they’ll try to minimize their liability in settlement-outside-the-court procedures as well.

Avoid the Messy Situation in the First Place

When you’ve been in a car accident, you should expect the expenses to skyrocket and insurance companies to be non-compliant.  

Insurance companies that pay your bills will try their best to minimize your claims. They’ll tell you that the terms of the settlement agreement don’t allow further compensation. They’ll insist that the pain and injury you’ve suffered is being exaggerated. They’ll ensure that the settlement you get is far less than what you deserve – it’s part of their jobs, after all. 

Right from the get-go, keep your figures high, fully understand your rights, and don’t settle too quickly. 

Know Your Rights

Do your research. Know what it takes to settle auto-accident claims, how pain and suffering are determined, what the insurance company’s policies are, and how strong your case is. Ensure that you have all the documents from the doctors, police, and witnesses that fortify your case and land you the settlement that you deserve.

Don’t Settle Too Quickly

It’s not always possible to look far ahead into the future, but there are certain things that you should be pre-planning: knowing when to settle in an auto accident is one of them. When you have insurance, the insurance company might:

  • Immediately pay the amount 
  • Refuse your claim and go down the route of negotiations. 

When it’s the latter, you’ll need a personal injury attorney. The initial offers are never reasonable, and you might be tempted to take the offer thinking something is better than nothing. Don’t do that.

An excellent lawyer usually waits until you’ve fully recovered to file a case or initiate negotiations on your behalf. This is because the case’s value can’t be determined until the treatments have ended and the expenditure is in a concrete and measurable form by the doctors. 

This means that there’s no standard time under which you should start negotiations because everyone’s recovery is unique to their case; we can’t plan that. However, we can know that settling in the middle of your recovery is never a great idea. 

Let your doctors decide the procedures’ costs, and your attorneys decide how to proceed with the case – until that can be done, it’s too soon to settle your car accident claim. 

Process for Submitting Medical Bills in California

To avoid getting into messy situations in the first place, do your research on medical bills before settling your claim. Here are a few must-know things:

  • You’ll have to run lots of diagnostic tests. Your doctor provides copies of them that you’ll need to send to the other party or your insurer 
  • Hold on to all of the notes, tests, treatments from doctors, chiropractor’s and orthopedics that date back at least five years. 
  • You’ll need to provide proof of substance abuse, psychological counseling, and other treatments you may have undergone for emotional distress

Knowing all of this is crucial because it will help you determine the proper settlement figures so that they don’t exceed after you’ve finished negotiations. 

Who Pays the Bills in Cases of Automobile Accidents?

A car accident in California might lead you to considerable loss of income and significant physical injuries. You’re wondering who’ll pay your medical bills: the defendant or the insurance company? Is there a third party you can involve?

In California, the party at fault usually has to pay the injured party’s medical bills and other damages. However, practically speaking, that doesn’t happen right away. With urgent medical bills pending, you’ll have multiple possibilities of paying your expenses in California. 

Insurance Companies

Ideally, your own insurance company should pay your expenses without delays. Insurance companies cover your medical expenses, but there are a few key points you need to consider.

  • The settlement compensation will depend upon the length of the treatment, how much insurance is available, and the party at fault in the car accident
  • The initial offer that you’ll get from the insurance company will most likely be unfair and unreasonable. Insurance companies won’t make a fair settlement until they’re sure they’ll lose a court case.
  • When you’ve filed a court case, you’ll be reimbursed within a month after the formal verdict instead of the negotiations that happen before suing, which conclude over an indefinite period.

With insurance companies paying your medical expenses, you can avoid unnecessary delays and receive a discounted amount. 

Car Insurance

If you were a passenger in someone else’s vehicle, there is a possibility that your medical expenses might be covered by the car owner’s auto insurance. This is called third-party liability insurance and sometimes covers deductibles and uncovered expenses from your own health insurance.  

A Lien on Your Settlement

In cases of special and visible damages, some healthcare providers place a lien on your case’s possible future settlement. A lien means that a doctor will allow you to pay them later after you’ve negotiated your settlement. However, it’s difficult to find medical practitioners who accept liens.

The Policy Limits When Paying Your Medical Expenses

If you’ve been in a car accident in California, your personal injury claim will be paid by an insurance company –yours or the defendants. 

If you’re suing a company, you might get a more extensive settlement, but automobile accidents are usually claimed against a defendant who’s a citizen like you and me. Therefore, you’ll only be recovering your compensation from the defendant’s insurance policy, which will most likely be limited. 

Policy limits are an unfortunate reality that you’ll have to deal with when you’re claiming medical expenses for your personal injury claims from an insurance company. The policies that limit you may be coming from the insurance companies – yours or the defendant’s – or they might be coming from the hospital if you’re uninsured. 

There are two courses of action you can take when there are policy limits:

  • When you’re insured, you can let the health insurance pay for most, if not all, of your expenses.
  • When you’re uninsured, you can negotiate with the medical providers directly.

Either way, you need an in-depth study of their policies and figure out the loopholes to negotiate a reasonable amount for yourself. 

When Are Medical Bills Higher than the Settlement?

When you’ve been in a California automobile accident, you have two options:

  • Personal  insurance 
  • A third-party claim with the insurance company or the at-fault party

Either way, your ‘pain and suffering’ will be measured against specific criteria and turned into a calculated amount.

How Is Pain and Suffering Determined?

Pain and suffering is a measurable amount on the grounds of which your settlement will be fixed. As a plaintiff, you’ll want to go higher, but you’ll want to ensure that the amount is lower as an insurance company or a defendant. 

The pain and suffering are calculated based on economic and non-economic damages, which include:

  • Seriousness of injuries
  • Possibility or chances of recovery
  • The blame of the plaintiff and defendants
  • The everyday impact of the injuries 
  • Property damage 
  • The emotional stress from the accident
  • Loss of past and future income
  • Loss of future earning capacity

Usually, these claims are solidified by doctor’s reports, but generally, these are subjective scenarios that differ on a case-to-case basis. 

When the Amount Exceeds Your Medical Bills

The settlement will be low and might exceed the medical bills if the insurance company can prove that:

  • The injuries aren’t serious
  • That there’s a higher chance of recovery
  • That the plaintiff shares the blame
  • There’s no significant impact on everyday functioning

Remember that the settlement offer doesn’t really reflect reality – you might deserve a better offer but cannot negotiate one for yourself against an adamant insurer. 

This is why it’s helpful to have a personal injury attorney on your team; they usually have years, if not decades, of successful negotiation tactics on their portfolio to ensure that you get good settlement numbers. 

The Patient Is Ultimately Responsible if the Bills Exceed

If your medical bills exceed the settlement you’ve negotiated after an auto-accident, unfortunately, you’re on your own. The injured is responsible for the bills that exceed the amount fixed in the negotiation process. 

California Auto Accident Settlement Process 

Settlement mostly happens to avoid the arduous court mechanisms that are a rough mix of unprecedented delays and an unpredictable jury. A settlement enables the parties involved in the negotiation process to have more control over the results of their claims. 

Generally, under California law, drivers are required to carry liability insurance with at least the following requirements:

  • In case of injury or death to one person, the drivers pay $15, 000 
  • In case of injury or death to more than one person, the drivers pay $30,000
  • In case of property damage, the drivers pay $5000
  • In case of a hit and run, you’re liable for a misdemeanor 

However, case-to-case dispute settlement methods include being compensated for past and future medical expenses, vehicle repairs, pain and suffering, which provides for economic and non-economic damages, and more. 

In San Francisco, California, you have about two years to file your claim with the court, before which you can engage in negotiations of the dispute. In cases of property damage, the limitation extends to three years. 

How Can an Attorney Help?

The legal ramifications of an vehicle accident in San Francisco, California can get a little complicated, especially when insurance companies are involved. This is why it’s crucial to have a personal injury attorney on your team who is well versed in car accident claims, like Phoong Law who can negotiate with your insurance company to determine your pain and suffering, and land you the settlement you deserve. 

They’ll guide you through the entire process, take on the arduous tasks so you can focus on recovery, and ensure that the settlement you get covers all your medical expenses. 

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Injury Lawyer, Anh Phoong, Esq.