Trial Attorney Blog
Every serious injury claim our firm handles has its own set of complications, but one of the most complicating facts we are often confronted with is the case where someone is seriously injured in an automobile or tractor-trailer collision and they have no health insurance. Indeed, regardless of the type of claim, whether it be a slip and fall, a products liability claim, medical malpractice or any other tort case, the lack of available health insurance oftentimes severely compromises our ability to obtain justice for our clients. This also severely compromises the ability of the injured individual to obtain the necessary care to improve their health. While we often read in the paper about the crisis of our healthcare delivery system when it comes to poor and the indigent, we see this crises every day in our practice when innocent victim/clients who are suffering are unable to afford needed healthcare.
In a typical case where someone is injured by the negligent acts of a third party, even if the third party has very good insurance coverage, we do not have a “pay as you go” rule which entitles the injured individual to have their bills paid as they are incurred. Instead, we have a system whereby once the claim is fully matured and all of the bills and expenses are known, the injured individual is entitled to reimbursement for such expenses assuming liability for the damages is established. In Georgia as in most jurisdictions, if someone is injured through the negligent acts of a third party, they are entirely on their own when it comes to medical treatment following the injury. In the hypothetical case where a tractor-trailer truck rearends an innocent motorist and severely injuries the occupants of the car, there is no duty of tractor-trailer company or its insurance company to provide the resources necessary for medical treatment needed on an ongoing basis. Instead, the injured individual is literally left to their own resources in terms of getting the treatment necessary to treat their injuries. If there is no available health insurance coverage, this makes it exceedingly difficult for the injured individual to get the treatment necessary to improve their health much less establish the legitimacy and the extent of their personal injury claim.
Injured individuals who have no health insurance have an extremely difficult time obtaining medical care. While emergency rooms cannot turn away an injured individual in an true emergency context, once the person is stabilized, the hospital has no duty to provide ongoing care to them. Thus, the injured individual who is in need of medical care, particularly diagnostic tests such as MRIs, CT Scans and the like have an almost impossible time securing such tests and obtaining the treatment necessary in follow up. Instead, they are left to their own devices in finding healthcare clinics, community health centers and/or doctors who will agree to treat them free of charge. If the injured individual is not qualified for Medicaid, Medicare or any other government sponsored program and has no private health insurance, what they will find is that most doctors do not want to treat them. Doctors do not work for free. They have overhead obligations obviously and therefore work for a profit. If they treat too many patients with no charge, they will go out of business. The same is true of any kind of service company, including lawyers. Thus, the injured individual is in a “Catch 22.” They have been injured through no fault of their own and they need medical care. They have no Medicare, Medicaid or health insurance and even though they need treatment, they can’t find it. Thus, they suffer needlessly and when it comes time to try to help them resolve their legal claims arising out of the accident, which was no fault of their own, there is little or no evidence to support the extent of the injuries because there is a complete absence of MRIs, CT Scans and other diagnostic tests available to confirm the nature and extent of the injuries.
This vicious cycle is often encountered in cases we handle for the poor and indigent. The victimization continues because the injured individual who has done absolutely nothing wrong is without the resources to obtain necessary medical care. Thus, it becomes imperative that the individual find a compassionate doctor or healthcare provider who will treat them on an ongoing basis subject to a lien for their services in the event there is a settlement or recovery in their personal injury claim. This complicates the case because the treatment is oftentimes not as good as it would be if there was full available health insurance coverage.
One solution to this problem is the option of purchasing Medical Payments coverage as part of ones own automobile insurance policy. Medical Payments coverage is similar to the old no fault coverage that used to exist in Georgia. If someone purchases Medical Payments coverage then, regardless of fault, if they are in a motor vehicle accident, their medical bills will be paid up to the extent of the purchased coverage. Thus, in a hypothetical case, if some one has purchased $50,000.00 in medical payments coverage, their bills will be paid up to the amount of $50,000.00 even if they cause their own injuries by running off the road and striking a tree without the negligence of any third party. Such coverage obviously is more important for those individuals who have no healthcare, however, if an individual cannot afford to have healthcare typically they cannot afford to purchase Medical Payments coverage as part of their automobile insurance policy. Thus, the vicious cycle continues whereby the victim of a serious injury claim not only must suffer from the injury sustained but they have difficulty obtaining treatment.
When we are confronted with these cases in our practice, obviously, we do what we can to help the client to obtain the necessary medical treatment. Many fine doctors have come forward to treat our clients free of charge pending the resolution of their personal injury claim. However, there are many cases where doctors will not do so and thus our clients suffer needlessly. The latter type of case is the most difficult to resolve because many times the documentation of the nature and extent of injuries is hard to develop due to the lack of available medical care for the injured individual.
If and when Congress makes universal healthcare available to all persons, this complicating feature of a serious injury claim will likely disappear. In the meantime, injured individuals have a very difficult time if they have no health insurance. While we as a law firm try to do everything within our power to help such individuals, a lack of resources always creates difficulties in any serious injury claim. Thus, we continue to hope that Congress will find a way to make health insurance available to all citizens so that the further victimization of innocent individuals injured through the negligent acts of third parties without any fault of their own will finally disappear.