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  1. #1
    Join Date
    Oct 2004
    Flint, Michigan

    Default Health Insurance and Car Accident

    I was in an accident when I was younger and had "impared bodily functions" as a result. I have been dealing with my auto insurance company for years, getting my first party medical benefits. Throughout that time they have paid to have a particular medical procedure done.

    All of a sudden they say they won't pay for all of the procedure. They say that Blue Cross is my primary insurance carrier and I have to submit the bill to them first, and that they will pay the balance.

    I have been assigned a new claims representative and he is the one that is doing this. Why is this now a problem and how can he do this?

  2. #2
    Join Date
    Sep 2004

    Default Coordinated Coverage - No Fault & Health Insurance

    Dear Teresa,

    It sounds like your new adjuster has informed you to submit claims first to Blue Cross, and that your first party insurance carrier will pick up any expenses not covered by Blue Cross.

    That is what is called "coordinated coverage" - your health insurance picks up the initial costs, and your first party auto insurance picks up the balance.

    The question then becomes whether the insurance policy covering your injuries was a "coordinated" policy, or was not coordinated. Most auto insurance policies have coordinated coverage, under which medical care is first paid for by your medical insurance, with the first party carrier picking up the balance (as the adjuster is trying to have done in your case).

    To find out whether or not your policy was coordinated, you should review your original policy language. Your adjuster should be able to provide you with a copy, if you don't have one. If you have difficulty understanding the policy, or cannot get cooperation, you should speak to a lawyer who practices first party no fault law for assistance.

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