How Health Insurance Works in a Car Accident in Washington?

After a car accident, medical treatment often begins before the insurance companies have decided who was at fault or how much a claim is worth. Depending on your coverage and the facts of the crash, health insurance in a car accident may involve personal injury protection (PIP), your regular health insurance, the at-fault driver’s bodily injury liability coverage, and sometimes uninsured or underinsured motorist coverage.

This guide explains how each type of coverage fits into the process, which insurer typically pays when, what happens when one source of coverage runs out, and how insurance reimbursement can affect a later settlement.

Understanding how these coverages fit together can help you keep treatment moving, reduce billing issues, and identify reimbursement problems before they affect your recovery.

Health Insurance vs. Auto Insurance Claim: Which Insurance Pays After a Washington Car Accident?

When several policies may cover the same accident, the key question is not simply which insurance exists, but which coverage is positioned to respond at what point, according to the circumstances. 

In Washington, the payment sequence for medical expenses frequently works like this:

1. Personal injury protection (PIP). If you have applicable PIP coverage, it is often the first source used for qualifying accident-related medical bills.
2. Health insurance. Once PIP is exhausted, denied, or unavailable, health insurance can pay for covered treatment subject to the plan’s deductibles, copays, network rules, and other requirements.
3. The at-fault driver’s bodily injury liability coverage. Washington is an at-fault state, so the driver who caused the crash may ultimately be responsible for your medical expenses and other losses. This coverage generally comes into play through a liability settlement or judgment.
4. Uninsured or underinsured motorist coverage. If the at-fault driver has no insurance or not enough coverage to compensate you fully, your own UM/UIM coverage may provide an additional source of recovery if you purchased it.

Using the correct coverage can help keep medical bills paid during treatment and affect what may need to be reimbursed from a later settlement. The sections below explain how each source of coverage fits into that sequence.

PIP in Washington  

Personal injury protection is generally the first source of payment for accident-related medical bills when you have applicable PIP coverage.

Unlike bodily injury liability insurance, PIP does not require you to establish that another driver caused the collision before benefits become available. It can pay qualifying medical and hospital expenses regardless of fault. That makes it particularly useful during the first weeks or months after a crash, when treatment may be underway but liability remains under investigation.

Washington does not require drivers to purchase PIP. State law instead requires auto insurers to offer it, and a policyholder who does not want PIP generally must reject it in writing.

Washington’s minimum PIP coverage includes several different benefits:

• Medical and hospital benefits—up to $10,000 per insured for covered treatment;
• Funeral expenses—up to $2,000;
• Income continuation benefits—up to $10,000, subject to a maximum of $200 per week; and
• Loss of services benefits—up to $5,000, subject to a maximum of $200 per week.

Insurers must also offer an increased PIP option with $35,000 in medical and hospital benefits upon request. Covered medical expenses generally must be incurred within three years of the accident.

For someone injured in a crash, the medical coverage is usually the most immediate part of PIP, but the other benefits can also matter when injuries keep you from working or performing services you normally handle at home.

Health Insurance  

Health insurance may cover car accidents. It generally becomes more important once PIP benefits are exhausted or when there is no PIP coverage.

Your health insurer may then pay eligible accident-related treatment under the normal terms of your plan. 

Depending on the plan, you may have:

• Deductibles,
• Copays or coinsurance,
• Network requirements, and
• Authorization requirements.

Because PIP in Washington is optional, not every injured driver will have this coverage available. If you rejected PIP or your medical benefits are exhausted before treatment ends, your health insurance may become the next source of payment for covered care.

Health insurance can also create a reimbursement issue later. If your health plan pays medical bills caused by another driver, the insurer may seek repayment from part of your eventual recovery. That issue is addressed through subrogation and reimbursement rather than through the initial payment of the medical bills.

The At-Fault Driver’s Insurance Pays Through the Injury Claim

Washington is an at-fault state, which means the driver who caused the crash can be held financially responsible for the injuries and losses they caused. Their bodily injury liability insurance is the coverage that responds to that responsibility.

Unlike PIP or health insurance, liability coverage usually does not pay your medical providers as treatment occurs. Instead, your medical expenses are included in the injury claim against the at-fault driver, along with other losses such as lost income, pain and suffering, and future medical needs.

In practical terms, you may use PIP and then health insurance to pay for treatment while your liability claim is being developed. Once your condition and losses are better understood, the at-fault driver’s insurer may resolve the claim through a settlement.

Part of that recovery may then be used to address unpaid medical bills or reimburse insurers that previously paid accident-related expenses. This reimbursement process, often referred to as subrogation in a car accident, can affect how much of the settlement ultimately remains with the injured person.

UM/UIM Coverage May Apply When Liability Insurance Is Not Enough

If the driver who caused the crash has no insurance or carries limits that are too low to cover your losses, uninsured or underinsured motorist coverage may become another source of compensation.

Washington generally requires qualifying auto policies to include or provide UIM protection, although an insured may reject certain UIM coverage in writing. UIM bodily-injury coverage may provide additional compensation when an at-fault driver’s liability insurance is unavailable or insufficient to cover damages for which you are legally entitled to recover. The specific coverage and limits depend on the policy and applicable law.

What Is Subrogation in a Car Accident Claim?

Subrogation is the process by which an insurance company seeks reimbursement after paying expenses for which another person was ultimately responsible.

For example, suppose your health insurance pays $30,000 for surgery and rehabilitation after a crash. You later recover compensation from the driver who caused the accident. Your health insurer may then claim a right to be repaid from part of that settlement.

Washington recognizes a “made whole” principle that can limit an insurer’s right to recover amounts it paid when an injured person later recovers from the party responsible for the loss. In general, an insurer seeking subrogation or reimbursement may not recover until the insured has been fully compensated for the loss, but the outcome can depend on the type of plan or insurer, the applicable policy or plan language, and the nature of the reimbursement claim.

That does not mean every reimbursement claim is automatically invalid. The amount owed can depend on the type of insurance involved, the terms of the policy, and how much compensation you actually recovered.

Get Help Sorting out Insurance After a Washington Car Accident

Understanding health insurance in a car accident can become complicated when PIP, health insurance, liability coverage, and reimbursement rights all affect the same claim. Sorting through a health insurance vs auto insurance claim also means knowing which coverage should pay first and what may need to be repaid later from a settlement.

Brett McCandlis Brown & Conner can review the insurance issues involved and explain how they may affect your Washington car accident claim. Contact our office for a free consultation to learn more about your legal options.

Legal References Used to Inform This Page

To ensure the accuracy and clarity of this page, we referenced official legal and other resources during the content development process:​

• Optional coverage for personal injury protection, Wash. Rev. Code § RCW 48.22.085.
• Underinsured, Wash. Rev. Code § RCW 48.22.030.
• Minimum personal injury protection coverage, Wash. Rev. Code § 48.22.095.
• Grp. Health Coop. v. Coon, 193 Wn.2d 841, 447 P.3d 139 (2019).