If you are injured in an accident
You might have questions about who will pay for your medical services if you are injured in an accident.
In most cases, when another person or entity is responsible for causing an accident, HMSA will not pay the cost of medical services related to the accident.
The following information can help answer questions about who pays for your medical care.
WHAT IS THIRD-PARTY LIABILITY?
Third-party liability occurs when you are injured or become ill and there is the possibility that you will recover damages or receive payment in connection with the illness or injury, whether another party is at fault or not.
HMSA requires members who have experienced an accident to notify us and to provide documentation so we can determine if we will be responsible for related costs. Your medical claims may be delayed or denied if we do not receive the necessary documentation.
Note: Please review the Third-Party Liability section of your Guide to Benefits for more information on your responsibilities, covered benefits, and exclusions.
NOTIFYING HMSA ABOUT AN ACCIDENT IS IMPORTANT TO:
- Ensure that your claims are not delayed or denied.
- Help determine who is responsible to pay for your injuries. We want to help you through the process.
- Ensure that HMSA is aware of injuries that must be covered by a party other than you or HMSA.
Note: Please review the Third-Party Liability section of your Guide to Benefits for more information on your responsibilities, covered benefits, and exclusions.
HOW DO I NOTIFY HMSA OF MY WORK-RELATED, MOTOR VEHICLE, OR OTHER ACCIDENT?
| Work-related accidents | |
| Motor vehicle accidents | - Submit a Third-Party Liability Injury/Illness Report.
- If benefits from your motor vehicle insurance have been exhausted, obtain a list of medical expenses with dates, provider name(s), and the amount paid by the motor vehicle insurance company that has paid for your services. If you have been denied, please provide a copy of the denial to the Third-Party Liability unit.
- Do not send duplicate forms unless requested to do so.
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| Other accidents | |
WHAT DOES HMSA COVER WHEN IT COMES TO WORK-RELATED, MOTOR VEHICLE, OR OTHER ACCIDENTS?
| Work-related accidents | - You are required to use worker's compensation benefits if they are available to you.
- HMSA does not cover work-related accidents that your worker's compensation insurance or another party will cover.
- For disputed/controverted cases, HMSA will apply plan benefits subject to our rights of reimbursement outlined in the Third-Party Liability section of your Guide to Benefits.
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| Motor vehicle accidents | - HMSA will cover medical services that are a benefit of your HMSA plan once the personal injury protection benefits of your motor vehicle insurance are exhausted. Please note, however, if you pursue a recovery for your injuries, any payments made will be subject to our rights of reimbursement outlined in the Third-Party Liability section of your Guide to Benefits.
- In some cases, your HMSA plan may also cover personal injury protection deductibles if our review of the case determines that benefits can be applied.
- Please be aware that you are responsible for any cost-sharing payments required by your motor vehicle insurance policy. HMSA does not cover these payments. In addition, you are also responsible for any HMSA plan copayments.
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| Other accidents | - HMSA does not cover services for which another party is responsible.
- HMSA covers medical services that are unrelated to the accident.
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Note: Please review the Third-Party Liability section of your Guide to Benefits for more information on your responsibilites, covered benefits, and exclusions.
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