Who Pays Medical Bills After a Car Accident in PA

Last updated October 5, 2026.

After a crash, the bills often arrive before anyone has figured out whose fault it was. Pennsylvania answers the first question, who pays the doctor, without waiting for the second. The system is called "first-party benefits": coverage on your own policy that pays your medical bills regardless of fault. This page walks through the order of payment, the limits, the deadlines and the traps. The wider picture of an injury claim, including fault and pain and suffering, is on the main personal injury page.

How do medical bills get paid after a Pennsylvania crash, step by step?

The Motor Vehicle Financial Responsibility Law, Chapter 17 of the Vehicle Code, sets the order. In practice it looks like this:

Report the crash to your own insurer. Within 10 working days of being notified of a claim, the insurer must acknowledge it and send the claim forms and instructions you need (31 Pa. Code 146.5(a), (d)).
Find the policy that pays first. If you are a named insured, it is your own policy. If not, it is a policy on which you are an "insured" because you live in the household of a relative who has one. Only after that does the policy on the car you were riding in pay (75 Pa.C.S. 1713(a)). The details for riders are in whose insurance pays when you are a passenger.
Your providers bill that insurer. Providers "may not bill the insured directly but must bill the insurer," and they may not collect from you the difference between their full charge and what the insurer pays (1797(a)).
The insurer pays within 30 days of proof. Benefits are overdue if not paid within 30 days after the insurer receives reasonable proof of the amount, and overdue benefits carry 12% interest a year (1716).
If the insurer questions the treatment. It can send the bill to a peer review organization within 90 days of receiving it, and while that review is pending you may not be billed for the treatment (1797(b)(1), (b)(3)).
When the medical benefit is used up. Health insurance and other medical plans are "in excess of" the auto benefit, so they pay after it, except that workers' compensation comes first for on-the-job crashes (1719(a)).
The claim against the at-fault driver. That driver's liability insurance answers for losses the benefits did not cover. The legal minimum is $15,000 for one person's injuries and $30,000 per accident (1702, "financial responsibility"). If that is not enough, the next stop is an uninsured or underinsured motorist claim.

Which policy pays first?

Order of payment for first-party benefits (75 Pa.C.S. 1713(a))
Priority	Who you are	Policy that pays
1	A named insured on any auto policy	The policy on which you are the named insured
2	An "insured": a spouse, relative or minor living in a named insured's household (1702)	The policy covering you as an insured
3	An occupant with no policy of your own or in your household	The policy on the vehicle you were in
4	A pedestrian or cyclist with no policy of your own or in your household	The policy on any motor vehicle involved in the accident
Last resort	A Pennsylvania resident with no coverage at all who does not own a vehicle that must be registered	The Assigned Claims Plan, up to $5,000 in medical benefits (1752, 1753)

When two policies sit at the same level, the insurer you claim against first must "process and pay the claim as if wholly responsible" and sort out contribution with the other insurer later (1713(b)). You should not be left waiting while two companies argue.

How much does the medical benefit cover?

The required minimum is $5,000 of medical benefits on every policy for a vehicle that must be registered (1711(a)). Insurers must also offer higher limits, and many people bought more without remembering it. The declarations page of your policy shows what you chose.

First-party benefits: required minimum and amounts insurers must offer (75 Pa.C.S. 1711, 1712, 1715)
Benefit	What it pays	Amount
Medical benefit	Reasonable and necessary treatment, including hospital, surgical, chiropractic, physical therapy, medications and ambulance	$5,000 required; insurers must offer up to at least $100,000
Extraordinary medical benefit	Medical costs above $100,000	Offered from $100,000 to $1,100,000; paid up to $50,000 a year after the first 18 months, $1,000,000 lifetime
Income loss	80% of actual lost gross income, starting after five working days are lost	Up to at least $2,500 a month, at least $50,000 total
Accidental death	Paid to the personal representative if the injury causes death within 24 months	Up to at least $25,000
Funeral	Funeral, burial or cremation costs within 24 months	$2,500
Combination benefit	An alternative package of the four benefits above	Up to at least $177,500, or three years, whichever comes first

Only the $5,000 medical benefit is mandatory. Income loss, death and funeral benefits exist only if you bought them (1712, 1715). The medical benefit has no time limit as long as, within 18 months of the crash, it is "ascertainable with reasonable medical probability" that further expenses may be incurred (1712(1)).

Can the hospital or doctor bill me directly?

For care covered by these benefits, no. Section 1797(a) caps what providers may accept at 110% of the Medicare-based amount for the service, or the provider's usual charge, whichever is less, with exceptions for Level I and Level II trauma centers and burn facilities, which may charge their usual and customary rate. The same subsection says providers "may not bill the insured directly but must bill the insurer," and may not try to collect the difference from you. If a provider sends you a bill for crash-related care while your auto benefits are still available, give the provider your auto claim number and ask it to bill the insurer.

If the insurer challenges treatment as unnecessary and a peer review organization later agrees with the provider, the insurer pays the outstanding amount plus 12% interest (1797(b)(5)). If the review goes against the provider, the provider may not collect for that treatment, and its failure to refund does not make you responsible (1797(b)(7)).

Can I make the at-fault driver pay back my medical bills?

Not the part your benefits already paid or would pay. Section 1722 says a person eligible for first-party benefits, workers' compensation or a health plan "shall be precluded from recovering the amount of benefits paid or payable" in a lawsuit against the at-fault driver. The other side of that rule is section 1720: there is no right of subrogation or reimbursement from your injury recovery for first-party benefits or for benefits paid by a health plan under section 1719. In plain terms, your auto insurer pays your first bills, you do not claim those same dollars from the other driver, and the auto insurer does not take them back out of your settlement.

What you can claim from the at-fault driver is everything else: bills beyond your benefits and health coverage, wage loss beyond any income benefit, and, depending on your tort option, pain and suffering. Whether a settlement for those losses is taxed is explained in whether a personal injury settlement is taxable.

What changes the answer?

A work crash. Workers' compensation is the one source that comes before the auto policy (1719(a)).
A motorcycle or off-road vehicle. The $5,000 requirement does not apply to motorcycle policies, and an operator or occupant of a motorcycle or an off-road recreational vehicle cannot recover first-party benefits under the Act (1711(a), 1714).
An uninsured car you own. An owner of a currently registered vehicle who does not carry the required insurance cannot recover first-party benefits at all (1714).
No coverage anywhere. A Pennsylvania resident hurt in a Pennsylvania crash who owns no vehicle that must be registered and has no other first-party coverage may claim up to $5,000 in medical benefits from the Assigned Claims Plan, but no income loss or death benefit (1752(a), 1753).
Your tort option. Limited tort never affects your medical benefits; it limits claims against the other driver for pain and suffering unless the injury is serious or an exception applies (1705(d)). One exception is a driver convicted of DUI, or accepted into ARD, for that crash (1705(d)(1)(i)); how ARD works locally is in ARD in Lawrence County.
Time. A lawsuit for unpaid first-party benefits must be filed within four years of the crash, or within four years of the last payment if benefits were paid; for a minor, four years from the 18th birthday (1721).

A worked example

For example, take a hypothetical Ellwood City driver, not a real client, rear-ended at a red light. She goes to the emergency room that evening and then has eight weeks of physical therapy. Her own policy, which she bought with the minimum $5,000 medical benefit, is first in line because she is its named insured (1713(a)(1)). The hospital and the therapist bill her auto insurer at the capped amounts, not her (1797(a)).

The capped bills come to more than $5,000. Once her auto benefit is used up, her health insurance pays the balance under its normal terms, because it is excess to the auto benefit (1719(a)). She misses three weeks of work, but she never bought the optional income loss benefit, so that loss becomes part of her claim against the other driver.

When she settles with the at-fault driver's insurer, she cannot claim the $5,000 her auto policy paid (1722), and her auto insurer has no right to be repaid from the settlement (1720). Her lost wages, any bills her health plan did not cover, and her pain and suffering, which depends on whether she chose full or limited tort, are the heart of the claim. Had the other driver carried only the $15,000 minimum, her own underinsured motorist coverage would be the next question.

Common mistakes with medical bills after a crash

Giving the hospital only your health insurance card. The auto policy is primary (1719(a)); billing health insurance first creates confusion and can leave bills unpaid.
Paying a crash-related bill out of pocket. Providers must bill the insurer and cannot balance bill you (1797(a)). Ask questions before you pay.
Assuming there is no coverage because you were a passenger or a pedestrian. The priority list reaches a household policy, then the occupied vehicle's policy, then any vehicle involved (1713(a)).
Letting the claim sit. Interest runs on overdue benefits only from the date they become due after proof is supplied (1716), and the four-year limit keeps running (1721).
Settling before the treatment picture is clear. A release usually ends the claim against the at-fault driver, even if you later need surgery. The steps that protect you early are in what to do after a car accident in Pennsylvania.
Not checking your declarations page. Many people carry more than $5,000 in medical benefits, or an income loss benefit, without knowing it.

What to do this week

Call your own auto insurer, open a first-party benefits claim and write down the claim number.
Give that claim number, not just your health card, to the hospital, doctors and therapists.
Find your policy's declarations page and note your medical benefit limit, any income loss benefit and your tort option.
Request the police report; how to do that is explained in getting a copy of your crash report.
Keep a folder of every bill, explanation of benefits and letter from any insurer.
If you missed work, ask your employer for a written statement of lost days and pay.
Do not sign a release or give a recorded statement to the other driver's insurer before getting advice.

Frequently asked questions

Does it matter who caused the accident?

Not for first-party benefits. Your own coverage pays your medical bills up to its limit whether you caused the crash or not. Fault matters for the separate claim against the other driver.

Will my premium go up if I use my medical benefits?

Not for that reason. "No surcharge, rate penalty or driver record point assignment shall be made as a result of an insurer paying a first party medical claim" (75 Pa.C.S. 1799.3(c)). Questions or complaints about an insurer can go to the Pennsylvania Insurance Department's consumer services line, 1-877-881-6388, listed in its auto insurance guide.

My insurer has not paid in two months. What can I do?

Benefits are overdue 30 days after reasonable proof, overdue amounts earn 12% a year, and an insurer found to have acted unreasonably also pays a reasonable attorney fee (1716, 1798(b)). Insurers must also explain any delay in writing at least every 45 days (31 Pa. Code 146.6).

Can a lawyer take a percentage of my medical benefits?

No. Fees for a first-party benefits claim may not be contingent fees or be deducted from the benefits; a lawyer may charge only a reasonable fee based on actual time spent (1798(a)). Fees for the claim against the at-fault driver are a separate arrangement, discussed up front.

What if I was hit while walking or riding a bicycle?

If no policy covers you as a named insured or household member, the policy on any motor vehicle involved in the crash pays your first-party benefits (1713(a)(4)). A parked, empty car counts only if it was parked so as to cause an unreasonable risk of injury.

What if my injuries came from a road defect, not another driver?

Your first-party benefits still pay first. A claim against the government for the road itself has its own notice deadline, explained in claims for a crash caused by a pothole on a state road.

Where would a lawsuit over the crash be heard?

For a crash in Lawrence County, usually the Court of Common Pleas in New Castle, where cases of $50,000 or less go to compulsory arbitration first under Local Rule L1301. The local courts are described on the Lawrence County courts page.

If a crash in Ellwood City, Lawrence County or anywhere in Western Pennsylvania has left you with bills and no clear answer about who pays, I can sort out the coverage with you. You work directly with me, and the first consultation is always free and confidential.

Who pays my medical bills after a car accident in Pennsylvania?