Who Pays Your Medical Bills While Your Injury Claim Is Pending?

You were hurt, and the bills started right away. The claim against whoever caused it could take months, and you may still be in treatment.

Here is the plain answer. The at-fault person’s liability insurer usually doesn’t pay bills as they arrive. It generally pays once, when your claim settles, often after your treatment ends. Until then, your own coverage pays: health insurance, Medicare or Medicaid, medical payments (MedPay) or personal injury protection (PIP) coverage on an auto policy, or workers’ compensation for a job injury. Several of these can claim repayment from your settlement later.

The rules here are current as of September 2026. Michigan rules are in the highlighted boxes.

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Why won’t the at-fault party’s insurer pay your bills now?

You have no contract with the other side’s insurer, and its primary obligation is to its own policyholder (Illinois Department of Insurance). It investigates and offers a settlement if it decides its insured is legally responsible (Utah Insurance Department), and there’s no guarantee it will pay (Texas Department of Insurance).

Its payment usually comes once, at the end:

• It pays for a release. To settle, the insurer will require you to sign a release: your agreement that the amount offered is all you’ll ever receive from its insured and from it (Utah Insurance Department).
• It waits for treatment to end. In most cases, Utah’s regulator says, an insurer won’t settle a bodily injury claim until you’ve completed all medical treatment.
• Settling early can cost you. A release ends the claim, so settling before you know how badly you’re hurt can leave later care unpaid. See what to say when an adjuster calls.

Federal rules expect the wait: Medicare treats a liability insurer that hasn’t paid within 120 days after the claim is filed or the care is given, whichever comes first, as not paying “promptly” (42 CFR 411.50(b)).

Who can pay your bills while you wait?

Your own coverage. More than one may apply, in an order set by your policies and your state.

Will your health insurance pay if someone else caused the injury?

Your plan generally pays covered care under its normal terms, with your usual copays and deductible. Check its coordination of benefits rules for how it works with MedPay or PIP.

The catch is repayment. Your plan’s contract may give it a right to be repaid from your recovery, called reimbursement, or a right of subrogation: the insurer takes over your right to recover what it paid (Cornell LII). Either claim against your settlement is often called a lien. Whether it can collect, and how much, depends on the plan’s terms and your state’s law. See how medical liens and subrogation work.

Employer plans and ERISA

Health plans that private employers set up are generally governed by ERISA, a federal law. Government and church plans generally aren’t (29 U.S.C. 1003). For repayment:

• Clear terms win. When an ERISA plan sues to enforce its repayment terms, the terms govern, and general fairness arguments can’t override them (US Airways v. McCutchen, 2013; 29 U.S.C. 1132(a)(3)).
• Silence on fees helps you. If the plan doesn’t address the lawyer’s fee, it generally must share the cost of getting the recovery (McCutchen).
• Self-funded plans are different. If your employer pays claims itself instead of buying insurance, state insurance laws that limit repayment claims generally don’t reach the plan (FMC Corp. v. Holliday, 1990).

Ask the plan administrator in writing for the plan documents, which ERISA requires it to provide (29 U.S.C. 1024(b)(4)). The summary plan description must say whether an insurance company guarantees the benefits (29 CFR 2520.102-3(q)).

What if you have Medicare?

Medicare is a secondary payer when liability insurance, no-fault insurance or workers’ comp is responsible for your care (42 U.S.C. 1395y(b)(2)(A)). But if that payer isn’t expected to pay promptly, Medicare can pay conditionally, meaning it must be repaid (42 U.S.C. 1395y(b)(2)(B)(i); 42 CFR 411.21, 411.52). CMS, which runs Medicare, says this is “so you will not have to use your own money to pay the bill.”

• No-fault coverage goes first. Medicare generally won’t pay until you’ve used coverage such as MedPay or PIP (42 CFR 411.50(b), 411.51).
• Report the case, as CMS requires, to its Benefits Coordination & Recovery Center (BCRC) at 1-855-798-2627. It lists the payments it thinks relate to your case, and you can dispute any that don’t.
• Repay within 60 days. Whoever receives the settlement money, including you and your lawyer, must repay Medicare within 60 days, even if the settlement admits no fault, and interest can be charged if repayment is late (42 CFR 411.22(b), 411.24(g), (h), (m)).
• Your costs are shared. Medicare generally reduces its recovery by its share of what it cost you to win the settlement, such as the lawyer’s fee (42 CFR 411.37). Its demand letter explains how to appeal or ask for a waiver (CMS).
• Medicare Advantage plans can recover the same way (42 CFR 422.108(f)).

What if you have Medicaid?

Medicaid is the payer of last resort: other coverage, including a liability insurer’s settlement, is supposed to pay first (Medicaid.gov). But if no other payer is available when a bill comes in, Medicaid pays it (42 CFR 433.139(c)), and the state then seeks repayment from anyone legally responsible for paying for your care, when the expected recovery exceeds the cost of collecting it (42 U.S.C. 1396a(a)(25)(B)). You must help the state pursue that repayment (42 U.S.C. 1396k(a)(1)).

The Supreme Court has limited what a state can take:

• Only the medical part. Under federal law’s anti-lien rule, the state can recover only from the part of a settlement that represents payment for medical care, not money for pain and suffering or lost wages (42 U.S.C. 1396p(a)(1); Arkansas Department of Health and Human Services v. Ahlborn, 2006).
• No formula you can’t challenge. A state can’t conclusively presume that a set share, such as one-third, is for medical care. If you and the state can’t agree, a court or agency decides (Wos v. E.M.A., 2013).
• Future care counts. The medical part can include money for future medical care (Gallardo v. Marstiller, 2022).

A provider that takes part in Medicaid can’t refuse to treat you because someone else may be liable (42 U.S.C. 1396a(a)(25)(D)).

Does your own auto or home insurance pay, whoever was at fault?

MedPay

Medical payments coverage on an auto policy pays for treating injuries to you and your passengers (NAIC). Texas’s regulator notes that it also pays if you’re hurt in someone else’s car or while walking or biking. Medicare’s rules describe MedPay and PIP as paying medical expenses “regardless of who may have been responsible for causing the accident” (42 CFR 411.50(b)). Your insurer may later try to recover what it paid from the at-fault driver’s insurer (Texas Department of Insurance).

Hurt on someone’s property? The owner’s homeowners or business policy may include medical payments coverage too (Texas Department of Insurance; 42 CFR 411.50(b)).

PIP in no-fault states

PIP pays for treating injuries to you and your passengers and can also cover lost wages and funeral costs, up to the policy limit (NAIC). Triple-I counts 12 no-fault states: Florida, Hawaii, Kansas, Kentucky, Massachusetts, Michigan, Minnesota, New Jersey, New York, North Dakota, Pennsylvania and Utah. There, PIP is mandatory, your own insurer pays first regardless of fault, and lawsuits against the at-fault driver are limited, though Kentucky, New Jersey and Pennsylvania let drivers keep the full right to sue. Some at-fault states add first-party benefits like PIP without limiting lawsuits (Triple-I); Texas policies include PIP unless you reject it in writing (Texas Department of Insurance).

See how no-fault and at-fault states handle a crash claim.

Bills piling up while you wait? Get a free case review. Four quick questions, no cost, no obligation.

What if you were hurt at work?

Workers’ compensation provides medical treatment and wage replacement for job injuries. Private-sector and state and local government workers claim through their state’s program (U.S. Department of Labor). Tell your employer and every provider it’s a work injury, so bills go to the comp insurer.

If someone else, such as another driver, caused it, you may also have a claim against them, and the comp insurer may be repaid from that recovery, depending on your state. See our workplace injury guides.

What if you have no coverage, or bills it won’t pay?

Letters of protection

Some providers will treat you now in exchange for a promise of payment from your settlement or judgment. Florida’s law calls this a letter of protection (Fla. Stat. § 768.0427(1)(d)). Rules differ by state. Before you agree to one, ask what you’d owe if the case is lost or settles for less than the bills, and get the answer in writing.

Ask, too, whether the provider could bill your insurance instead. In Florida, if you have health coverage but treat under a letter of protection, the evidence of your medical damages can include what your coverage would have paid (Fla. Stat. § 768.0427(2)(b)2).

Medical and hospital liens

Some states give hospitals, and sometimes other providers, a lien on your injury claim by statute, with notice rules and caps. For example:

• Illinois: All providers’ liens for their reasonable charges can’t together exceed 40% of your recovery, and no one type of provider can take more than one-third (770 ILCS 23/10).
• California: A hospital’s lien for its reasonable and necessary charges requires written notice to those alleged to be liable before they pay you (Cal. Civ. Code §§ 3045.1, 3045.3), and is paid from no more than half of what’s due after earlier liens (§ 3045.4).

Other states’ rules differ. And federal rules for nonprofit hospitals don’t treat a state-law lien on your injury settlement as an “extraordinary collection action,” so a hospital can assert one without first checking whether you qualify for financial assistance (26 CFR 1.501(r)-6(b)(3)).

Can you get a surprise bill for emergency care?

If your health plan covers emergency care, the federal No Surprises Act protects you from surprise out-of-network bills. The hospital and the providers treating you there can’t bill you more than your plan’s in-network cost-sharing (your copay, coinsurance and deductible) for emergency services (45 CFR 149.410; CMS). Your plan must cover emergency services without prior approval (45 CFR 149.110).

• Who’s covered: most private insurance, including employer, Marketplace and other individual plans (CMS).
• After you’re stable, the protection generally continues, unless you sign an out-of-network provider’s notice and consent form giving it up (CMS). Read before you sign.
• Ground ambulances aren’t covered, though some states protect you. Air ambulances are (CMS).
• Not using insurance? For care you schedule at least three business days ahead or ask about, providers must usually give you a good faith estimate. If the bill is at least $400 higher, you may be able to dispute it within 120 days of getting it (45 CFR 149.610, 149.620). This also covers people who have job-based or individual health insurance but choose not to have the claim sent to it (45 CFR 149.610(a)(2)).

CMS’s No Surprises Help Desk: 1-800-985-3059.

How can you lower bills you owe yourself?

• Get an itemized bill. Your right to copies of your health records covers billing records, generally within 30 days and for a reasonable, cost-based fee (45 CFR 164.501, 164.524). With Medicare and a pending claim against a liability insurer, a hospital must give you an itemized bill on request (42 CFR 411.54(c)). Look for duplicate charges and care you didn’t get.
• Ask a nonprofit hospital for financial assistance. Tax-exempt hospitals must have a written financial assistance policy for emergency and other medically necessary care (26 U.S.C. 501(r)(4); 26 CFR 1.501(r)-4(b)(1)). It must be posted online, free on paper and flagged on your bills (26 CFR 1.501(r)-4(b)(5)). If you qualify, the hospital can’t charge you more than it generally bills people with insurance for that care (26 U.S.C. 501(r)(5)).
• Apply early. The hospital must accept applications for at least 240 days after its first bill after you leave (26 CFR 1.501(r)-1(b)(3)). It generally can’t report you to a credit bureau, sell your debt or sue you until it has made reasonable efforts to see whether you qualify, such as notifying you and waiting at least 120 days after that first bill (26 CFR 1.501(r)-6).
• Ask for a payment plan, and tell the billing office your injury claim is pending.

What to do next

1. Give every provider every coverage you have, and ask them to bill it now: your health plan, Medicare or Medicaid, your auto claim number for MedPay or PIP, and your workers’ comp claim number for a job injury.
2. Report the case and keep records. If you have Medicare, report the case to the BCRC at 1-855-798-2627. Keep every explanation of benefits, bill and letter in one folder.
3. Check and reduce what you owe with itemized bills, financial assistance and good faith estimates.
4. Read before you sign a letter of protection, a lien notice or a notice and consent form.
5. Get a free case review before you settle. A lawyer can sort out who must be repaid and estimate what you’d take home. Get a free case review, or compare Michigan injury lawyers. See what else comes out of a settlement and how to size up what your claim is worth.

What waiting can cost

• A missed billing deadline. A bill held for your settlement can miss an insurer’s claim deadline. Medicare’s is generally one year after the date of service (42 CFR 424.44(a)(1)).
• Collections. After reasonable efforts to check whether you qualify for help, a nonprofit hospital can report the debt to credit bureaus (26 CFR 1.501(r)-6).
• Your claim’s own deadlines. In Michigan, for example, you generally must give your auto insurer written notice of your injury, or notify the Assigned Claims Plan, within one year of the crash (MCL 500.3145(1), 500.3174).

What a good outcome looks like

Your bills go to the right coverage as they arrive, so nothing lands in collections while you heal. Every payer that expects repayment is found early and held to its own rules, such as Medicaid’s limit to the medical part of a settlement. When your case settles, those claims are paid, and you know before you sign what you’ll take home. For the bigger picture, see our complete personal injury guide.

Updated September 25, 2026

This guide is general information, not legal advice, and laws change. For advice about your situation, talk to a lawyer licensed in your state. Reading this page or contacting us does not create an attorney-client relationship.