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What Are Accident Benefits?

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Find out everything you need to know about the benefits you’re entitled to after an accident.

If you had your way, this accident wouldn’t have happened in the first place. But now that it has, you need to know what benefits are available to help you get better and get your life back on track.

Medical Benefits

When you’re hurt in an accident, having medical benefits can make all the difference. You need this care to get better – and you need money to afford the care.

When a car accident occurs, you’re eligible for medical benefits through an auto insurance company.

What Medical Benefits Are Available?

Medical benefits through an auto insurance policy cover the cost of medical care, including:

  • Emergency room visits
  • Diagnostic exams
  • Medical treatments
  • Chiropractic care
  • Physical therapy
  • Surgery
  • Rehabilitation

You can use your medical benefits for inpatient care at hospitals and rehab facilities. Or for outpatient physical therapy and doctors’ appointments.

Unlike a health insurance company, your auto insurer can’t limit what doctors you can see or hospitals you can visit. But there are limits to how much care you can receive.

Your medical benefits come from your personal injury protection (PIP) coverage.

  • New Jersey auto insurance policies may have up to $250,000 of PIP coverage (or more), but some policies may have just $15,000 in coverage.
  • In Pennsylvania, PIP coverage can be as low as $5,000.

Medical Benefits in No-Fault States

When you’re in a car crash in New Jersey or Pennsylvania, it’s your own auto insurance policy that pays your medical benefits.

Why? Because NJ and PA are both no-fault states.

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This doesn’t literally mean that no one is at fault for the accident. Of course someone was.

But no-fault laws mean that your own insurance company has to pay your auto accident-related medical bills regardless of who is at fault.

That’s true even if you weren’t driving – if you were a passenger or even a pedestrian struck by a car.

The Pros and Cons of No-Fault Insurance

The good thing about no-fault laws is that you don’t have to wait for the insurance companies to figure out who is at fault to get medical benefits. But there are definitely drawbacks.

For one thing, it’s frustrating that the bills fall on you when the other driver is at fault.

For another, your medical benefits aren’t free – you bear some of the financial responsibilities, too. (More about this later.)

And, of course, no-fault laws leave passengers and pedestrians who aren’t covered by their own auto insurance policy in a confusing position. Figuring out who pays for the medical bills in these cases can be complex.

The Health as Primary Option

There’s an exception to this law. If you make a certain choice setting up your auto insurance policy, you might have to go through your health insurance company instead of your auto insurance policy. This means your insurer will be able to restrict which doctors you can see – and you may end up paying more money out of pocket.

Wage Loss Payments

Did you know that your auto insurance policy might also include wage loss payments?

Many policyholders don’t. They often never know when they buy the insurance that they can upgrade their policies to provide a higher wage loss payment for very little added cost.

But even if you didn’t purchase extra wage loss coverage, you’re probably still entitled to at least some benefits – like $100 per week.

It may not sound like much when you’ve got bills to pay, but an extra $400 per month when you’re out of work can make a big difference.

The problem is that many policyholders don’t get these payments, because don’t know about the benefit. Even our injury attorneys have many run-ins over the years with insurance adjusters who tried to wriggle out of paying wage loss benefits.

Because we handle car accident cases every day, we know when the insurers are misrepresenting the facts. We know when they are unreasonably delaying payments. We know exactly what paperwork is required to process wage loss payments.

And, if adjusters continue to be uncooperative, we know to go over their heads. More than once, we have spoken toan adjuster’s supervisor to demand that they pay the benefits our clients deserve.

But accident victims who are trying to handle their own claims don’t know these things. And many of them, unfortunately, get taken advantage of by their own insurance company.

Vehicle Damage

Getting your car fixed after an accident can be more complicated than you would expect. The process depends on whether you go through your own auto insurance or the policy of the other driver – assuming he or she is at fault.

Property Damage Benefits Through Your Own Insurer

Choosing to have your own insurer pay for the vehicle repairs often means you can get your car fixed sooner –a big deal if the damage is so bad that the care isn’t drivable in the meantime.

But there are disadvantages. You’ll have to pay a deductible of hundreds or even thousands of dollars out of pocket. You might get this money back, but there’s no guarantee – and even if you do, it could take some time.

And, depending on the insurance coverage you purchases, this might not even be an option for you. If you weren’t carrying collision coverage, going through the at-fault driver’s insurer or paying for the damage yourself could be your only options.

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Getting Your Car Fixed Through the Other Driver’s Insurance Company

If you have the at-fault driver’s insurance company pay to fix your car, you won’t have a deductible to pay. But you should be prepared for a long wait.

The other insurance company won’t pay to fix your car unless it decides that its own policyholder is at fault – which isn’t something the insurer wants to admit.

Even if liability for the crash seems clear to you, your insurance company, and the police, the other driver’s insurance company will want to investigate. And that means you could be stuck with a damaged car, or without a drivable car at all, for some time.

What’s the Cost of Accident Benefits?

Isn’t there always a catch? Unfortunately, yes – these accident benefits aren’t just given to you.

Even though you already paid for the privilege of having coverage through your premiums, you’ll have to pay again in the form of deductibles and copays. When your own insurer pays for something – like medical care or vehicle repair – you have obligations, too.

Often, deductibles range from $250 to $2,500. Choosing higher deductibles can lower your premiums, but if you need to use the coverage, this choice could cost you. You may have different deductibles for property damage and medical benefits, so make sure you find out what you actually have to pay.

When it comes to medical care, you also have to make copays of 20 percent of the cost of treatment up to the first $5,000.

There are limits on how much you can be forced to pay. If you chose a $250 deductible, you could have to shell out up to $1,200 between the deductible and the copays. But if you went with a high deductible like $2,500, you could be looking at $3,000 that you – not your insurance company – must pay.

Compensation You Can Only Get by Pursuing a Personal Injury Claim

What about other damages, like the pain and suffering you endured because of the accident?

As significant as your pain is, this isn’t a benefit an insurer will give you. To get compensation for pain and suffering, you’ll need to pursue a personal injury claim.

Of course it’s helpful to have medical benefits, wage loss payments, and property damage coverage available to you from the start. But filing a personal injury claim is necessary for accident victims with serious injuries to be made whole again.

What About Benefits for Accidents that Don’t Involve a Car?

Not all serious injuries involve a motor vehicle. For accidents that instead occur on dangerous properties, you don’t have the accident benefits available from an auto insurance policy.

You may need to pursue a personal injury claim to have any hope of recovering some of the same damages that, for a car accident victim, would be covered automatically.

But you may still be entitled to some accident benefits. For example, some commercial property and homeowners’ insurance policies include a medical payments, or “med pay,” coverage that provides benefits no matter who is at fault for the injury.

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Finding out what coverage is available and whether you’re eligible for med pay can be a challenge. It may take some investigation, not to mention some back-and-forth with the insurance company. That’s why it’s often a good idea to have a lawyer handling your case and helping you sort out questions about accident benefits.

When it comes to getting the accident benefits you deserve, knowing what you’re entitled to is everything. If you have questions about insurance benefits after an accident, give us a call at (856) 778-5500 for help understanding what’s covered.

Disclaimer: Results may vary depending on your particular facts and legal circumstances.

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This article was professionally reviewed by Richard P Console Jr, an attorney licensed to practice in New Jersey, New York, and Pennsylvania.

Mr. Console has more than twenty years experience practicing personal injury law and successfully resolving vehicle accident claims on behalf of his clients.

Learn more About Richard P Console Jr.

While this information was reviewed for accuracy, it should not be considered legal advice. Every claim is different. If you are thinking of pursuing a personal injury claim and have a question contact us directly. 

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