New York Personal Injury Law Blog » Health Care, No-Fault, Personal Injury


March 21st, 2010

Health Care Bill: Benefits For Personal Injury Victims

The health care reform bill should be a big benefit to personal injury victims. Traditionally, those people most put at risk after accidents were the middle class uninsured. Poor people have Medicaid to fall back on and others have private insurance. Now there will be an additional 32 million with coverage.

While in theory auto accident victims have had No-Fault insurance in New York to protect them, and the bill shouldn’t matter, that is theoretical only. In New York, insurers have long enjoyed a reputation for cutting off benefits to victims after sham medical exams by “independent” examiners hired by the insurance companies. These doctors are anything but independent. Victims are often told that they aren’t injured, despite the pain they are in and their restrictions of motion. Or that the pains that they have are “preexisting” despite the fact that they felt fine before the accident.

Medical malpractice victims, of course, don’t even have the No-Fault.

So with more of the victims covered by their own insurance, we are likely to see these positive effects, the first of which is obvious and the second two more subtle, but most definitely important:

First: People that were previously left to the mercies of existing no-fault laws and the spotty medical care that they provide can continue to get care and, to the extent treatment benefits the quality of life, be healthier.

Second: If an individual believes others are at fault and starts a lawsuit, the injuries that they suffered will be documented by treating medical practitioners. Currently, if a patient stops treating, that is an issue that defense attorneys love to harp on in front of juries. Without having their doctors treating them, plaintiffs must tell juries that the reason they aren’t treating is that they can’t afford it. And with that, their credibility can be attacked, which is far easier than attacking the credibility of multiple physicians, because the plaintiff is an “interested party” in the outcome of the suit.

Third: The existence of continuing health care hamstrings liability insurers that oft times will rush in to accident victims with low ball offers before they have consulted with attorneys. When there is no other insurance or No-Fault gets cut off, and a victim that may not be able to work, a $5,000 offer may be desperately needed money. With the injured already knowing they are covered, they won’t be as vulnerable, and will be in a better position to sit back and objectively evaluate their situation.

So, all in all, this is a good situation for those who have been injured, beyond the most obvious point of simply being able to obtain health care.

7 thoughts on “Health Care Bill: Benefits For Personal Injury Victims

  1. Eric:

    This is very insightful regarding the benefit to some victims of personal injuries. In addition to those you mentioned, persons who are injured by defective products, persons injured as a result of premises defects, and workers (mostly recent immigrants) who are injured in work-related accidents for which their employers have not obtained worker's compensation insurance to cover them. Presumably all or most of the members of these classes will now have the ability to obtain the health care they need to properly treat their injuries.

    David E. Waterbury
    New York, NY

  2. Yeah, there are certainly others. But if those immigrant workers who don't have Workers Comp get injured, this bill might not help since I think there was an exclusion for many of them (depending on immigration status).

    When it comes to workers, I suspect that the most vulnerable will still be vulnerable.

  3. I don't doubt that there is a small percentages of claimants who discontinue treatment for financial reasons, but there is also a small percentage that will use this so-called reform (I call it Healthcare Deform) to run up medical bills in order to have larger numbers to blackboard before a jury

  4. but there is also a small percentage that will use this so-called reform (I call it Healthcare Deform) to run up medical bills in order to have larger numbers to blackboard before a jury

    Well, the potential for fraud always exists, regardless of the system. That exists both for people trying to game a system and for insurance companies conducting sham exams to cut off benefits.

    But we don't close down banks, for instance, because there are potential bank robbers out there. We try to build better systems to prevent against crime.

    And as to the number of people that discontinue coverage due to financial reasons, I don't believe at all that the number is small. The number of uninsured is obviously quite large, and bankruptcy due to injuries and subsequent medical bills has clearly been a real problem.

    Being unable to work due to an injury combined with no health care is a problem that can rapidly devastate a family.

  5. Any idea whether the bill creates greater lien rights for insurers? I'd be surprised if it didn't. Could be a double-edged sword if insurers get the same statutory right of recovery as CMS.

  6. Any idea whether the bill creates greater lien rights for insurers? I'd be surprised if it didn't.

    Not in New York. We have a new law that protects plaintiffs from insurance companies reaching in to take any part of a settlement.

    I can't speak, however, as to how it affects those outside NY.

  7. Another thing is that medical fund insurers should not miss out in law suits because the costs of treatment will be recoverable against successful personal injury claims. That is why the Australian version of tort reform was a sham because it means that our welfare and universal health care systems were left with the expense of paying for the injured. ie the taxpayer now has the expenses not the tortfeasor.
    Also insurers and your country more broadly also benefit from reduced awards because now plaintiffs will be in a position to mitigate their damages by access to proper care. Good luck from Australia in world of socialised medicine.