Liability for Injury: Insurance Options

This article provides answers to common insurance questions, including:

• Whose insurance company pays for an injury?
• What types of insurance cover injuries?
• Can I file claims under multiple policies for the same injury?

Whose Insurance Company Pays for an Injury?

Insurance liability depends on a few factors, which include:

• The circumstances surrounding the injury, such as negligence
• The insurance type and policy terms, such as whether it uses a fault system
• State insurance laws, particularly for fault and coverage requirements

Auto accidents are a common scenario that involves injuries and insurance claims. Some states use a fault system, which generally means that the person who caused the car crash is responsible for the damages. The at-fault driver’s insurance company would pay for the injured person’s claim. This type of claim is a third-party claim.

Sometimes, both drivers contributed to the conditions that caused an accident. State laws influence how much an insurer would need to pay the drivers.

In no-fault states, it doesn’t matter who caused the accident. Each driver files a claim with their own policy to cover the damages. This type of claim is a first-party claim.

Unlike car insurance, some types of insurance don’t depend on who caused the injury. Your health insurance and workers’ compensation policies are two examples of no-fault insurance.

What Types of Insurance Cover Injuries?

The available type of insurance coverage depends on the circumstances, such as where and how your injury happened. You might file a first-party claim under your insurance policy. A third-party claim may be filed under someone else’s insurance policy. Let’s take a look at the different types of insurance and what they cover (and don’t cover).

Homeowner’s Insurance

Homeowner’s insurance protects against damage to the home and items inside it. This type of insurance may protect you from accidents that happen at your home. In general, homeowners are liable for injuries that happen on their property due to their actions or negligence. Separate policies may cover liability or certain high-risk natural disasters.

Renter’s Insurance

Renter’s insurance is a subset of homeowner’s insurance for tenants. Many landlords require renters to hold an insurance policy. This policy protects against damage to the physical property being rented and may also cover personal injuries within the home.

Car Insurance

All drivers must carry a minimum amount of motor vehicle insurance under state law. It covers all road vehicles (trucks, cars, motorcycles, etc.).

Auto insurance can protect against both vehicle damage and bodily injury resulting from a crash through:

• Personal injury protection coverage (PIP), which can cover your own injuries regardless of accident fault
• Bodily injury liability coverage (BIL), which covers your responsibility to pay for someone else’s injuries after an accident
• Uninsured/underinsured motorist coverage (UM/UIM), which means your own insurance company will pay if the at-fault driver’s insurance wasn’t enough to cover your injuries
• Collision coverage, which covers damage to your vehicle but doesn’t apply to your injuries
• Property damage liability insurance, which covers damage to another driver’s vehicle if you’re at fault for the accident

Each type of coverage may have a separate cap, which limits the amount of compensation you can claim in that particular damage category. The cheapest policy might not have enough coverage for the costs of serious injuries, and you’ll be expected to pay the difference out of your pocket. Lack of insurance can expose the policyholder to the risk of a lawsuit. That’s why some drivers pay a higher premium to get more coverage.

Health Insurance

When you need medical care, you may rely on your health insurance policy. Your injuries likely need emergency care, so you’ll probably reach for your health insurance card first.

Health insurance policies cover medical payments for eligible care regardless of fault. They don’t cover other injury-related damages like lost income and property damage.

Life Insurance

A fatal accident or injury can lead to a life insurance policy claim. Life insurance protects insured individuals from the financial losses associated with death. Designated beneficiaries receive payment of benefits upon the policyholder’s death.

Business Owner Policy (BOP)

BOP insurance is a bundle of the mandatory coverage a business owner needs, such as:

• Business interruption insurance
• Property insurance
• Vehicle coverage
• Commercial or product liability insurance
• Crime insurance

If a business owner is liable for your injuries, this policy package may cover the costs. Consider a slipping accident on a wet floor in a store. The store owner is liable for failing to take reasonable steps to prevent the slip-and-fall accident. Their insurance may cover the damages of the resulting injury.

Workers’ Compensation Insurance

If your injury happened at work, your employer’s workers’ compensation insurance can cover your losses. This type of insurance doesn’t focus on fault. State laws usually require most employers to carry this type of policy to protect injured workers.

Medical Malpractice Insurance

Many medical providers are required to carry an insurance policy for malpractice claims. If your injury occurs due to medical negligence, such as a botched surgery or delayed diagnosis, you’d likely seek compensation from the malpractice insurance company.

Can I File Claims Under Multiple Policies for the Same Injury?

Yes, you can, but only if each one covers different aspects or amounts of your damages. Some scenarios will involve more than one insurance company.

You can’t get extra spending money by filing duplicate insurance claims for the same damages. The law prohibits using insurance claims to make a net profit, even if you carry extra insurance coverage. Tricking the insurance companies to pay double compensation would be a form of insurance fraud.

Overlapping Coverage

Some people have insurance policies that cover the same risk. For example, you might have two health insurance policies: one through your employer and the other through your spouse’s employer.

One policy would be the primary insurance, and the other policy would be the secondary insurance. Insurance adjusters use coordination of benefits (COB) rules to determine which companies need to pay for a claim and, if so, how much. This system prevents double-paying for the same claim.

Policy Limits and Backup Insurance

An insurance policy only covers eligible losses up to the policy limit. The costs of an injury may exceed that limit, but the insurer won’t pay more. Instead, the injured person may use another policy for the remainder.

For example, imagine an auto accident injury is so severe that it incurs $35,000 in medical treatment and rehabilitation. The other driver was 100% at fault for the accident. Their car insurance policy limit is only $25,000 for bodily injury. You also have a car insurance policy with a UIM coverage limit of $20,000. Together, the policies cover up to $45,000, which is enough to fully cover your costs after meeting the deductibles.

What if you didn’t have UIM coverage? The driver’s insurer would only pay up to $25,000  to settle your claim, leaving you with the remaining $10,000 in expenses. As a last resort, you could try to sue the driver directly with the help of a car accident attorney. Otherwise, you may be stuck paying for the rest on your own.

Subrogation Can Redirect a Claim Payment

Insurance and legal processes take time, but you may have expenses for things like medical care demanding payment. A health insurance policy can help manage medical bills in the meantime.

If another company is supposed to pay for the claim, your insurer won’t want to simply absorb the cost. It will want to correct the flow of money between companies. In this situation, the insurer can start a process called a subrogation action. It can try to claim part of the insurance settlement to reimburse what it has already paid for the same injury. State laws regulate this type of action.

To illustrate, here’s what might happen after a surgeon operates on the wrong organ:

1. You get corrective surgeries at the hospital, which charges the medical expenses to your health insurance. You pay some of these surgical expenses out-of-pocket until you reach your policy’s deductible, and your insurance company covers the rest.
2. You hire a personal injury lawyer to file a medical malpractice lawsuit against the negligent surgeon’s insurance company. Preparing for the case takes over a year and you don’t know if you’ll win. This allows you to appreciate your health insurance company initially covering your costs.
3. Before your case reaches trial, your attorney negotiates a settlement with the medical malpractice insurer. The settlement includes money for your medical treatment, which the health insurer already paid.
4. Your health insurance company successfully recovers part of the settlement through subrogation, and it returns the deductible you originally paid.

In the end, both insurers technically paid the claim, but only one insurer actually absorbed the cost.

Questions About Liability and Insurance? Ask an Injury Attorney

Liability can sometimes be the primary focus of a personal injury claim, especially when it comes to dealing with insurance companies. Failure to establish liability could put your claim in jeopardy. An insurance company might deny your claim.

Hiring an attorney who knows the relevant laws in your state and the various insurance options that may be available to you can make all the difference. An experienced injury law attorney will examine your case, explain your options, and stand with you during all legal proceedings.