Medical Bill Insurance Claims in Sidewalk Fall Accident Cases in Pennsylvania

Can You Make an Insurance Claim for Medical Bills After a Sidewalk Fall Accident?

Did you or a loved one have a fall accident on a sidewalk in Pennsylvania? If so, you may be eligible for financial reimbursement for medical bills by making a special insurance claim. The claim is made under the business, homeowner or renter insurance policy covering the property where the accident occurred.

For a fall accident that occurs at a business like a grocery store or retail store, the claim would be made under the insurance policy covering the store property. For a fall accident that occurs on a sidewalk in front of a private home, the insurance claim would be made under the homeowner or renter insurance policy, if there is one.

This is something most people who are injured in sidewalk fall accidents don’t know, and it’s true of all fall accidents whether they occur in Philadelphia or a suburb like Delaware County or Montgomery County.

What is med pay and are you eligible?

Insurance policies offer a variety of coverage options. One of them is medical coverage or med pay coverage. It provides payment to a person who incurs medical bills due to an accident on the covered property. The key is that the accident must have occurred on the actual property, and the injured person must have incurred medical bills. Med pay doesn’t apply and provide compensation for an injured person who doesn’t have medical bills.

Example – Not Eligible for Med Pay: You sprain your ankle in a sidewalk fall accident while on a walk in your neighborhood. You don’t need any medical treatment and your ankle gets better with ice and rest. You wouldn’t be eligible for med pay.

Example – Eligible for Med Pay: You break your ankle in a sidewalk fall accident and incur over $5,000 of medical bills. You would be eligible for med pay benefits from the insurance policy covering the property where you fell because you incurred medical bills.

How do you make a claim for med pay?

To make a claim for med pay, you will need to make a claim under the applicable insurance policy, which can only be obtained by getting the info from the property owner (which is not advisable) or filing a legal action against the property owner. This latter action would trigger a claim with the insurance company. You could then request the med pay benefit.

It is never advisable to contact a property owner after a fall accident. There’s too much risk in doing so from a legal standpoint. What you say and do can be used to limit your med pay benefits and may negatively impact any lawsuit you might file against the property owner. If you have a valid negligence lawsuit for a fall accident due to defective sidewalk, speaking to the property owner would likely backfire. The same is true of contact with the insurance company.

For example, you may jokingly say that you need to watch where you’re walking. This is like admitting that you bear some fault for the accident because you weren’t watching where you were walking. This could sink your case or reduce your financial recovery. That’s why it’s always best to have a fall accident lawyer contact all parties and insurance companies.  

There are two things to know about filing a med pay claim.

  1. The max benefit amount varies.
  2. The filing deadline also varies.

These insurance policies are contracts, which means that the benefit amounts, terms and conditions vary. Pennsylvania law doesn’t require a minimum med pay amount on these kinds of insurance policies, although it does for car insurance policies (there’s a minimum of $5,000 medical bill coverage via PIP claim after auto accidents). Therefore, the med pay coverage amount on a business or homeowner policy will vary. $5,000 or $10,000 are common coverage amounts.

The same principles apply to the time deadline to make a med pay claim. They are largely determined by the terms and conditions of the insurance policy. Some insurance companies put a 1 or 2 year time limit on med pay claims.

What happens after you make a med pay claim?

The insurance company will do its own investigation to ensure you’re eligible. Once that’s done, you may either receive a reimbursement if you paid for medical bills out of your own pocket (including co-pays and deductibles). This tends to be the most common situation. Alternatively, you might be able to submit unpaid medical bills directly to the insurance company. This is not as common because by the time you make a med pay claim, you will have already paid most if not all of your medical bills.

Personal injury cases accepted in Philadelphia, Delaware County, Montgomery County, and throughout other parts of Pennsylvania and New Jersey.



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