Who pays the medical bills after a Texas crash: PIP, UM or the other driver's insurer

Several policies can pay, and the timing is different for each

After a Texas car accident, your medical bills are usually paid first by your own coverage, such as personal injury protection (PIP), medical payments coverage or your health insurance, and later reimbursed or compensated through a claim against the at-fault driver's liability insurance. If the at-fault driver has no insurance or too little, your own uninsured or underinsured motorist coverage can step in. The other driver's insurer generally does not pay bills one at a time as they arrive; it pays when the injury claim is resolved.

I am a founding partner at Garcia, Garcia & Mullen, and personal injury is my practice. This is one of the most stressful questions my clients face, because the bills start coming before anyone has accepted responsibility. Understanding the order of payment takes a lot of that pressure off. What follows is general information about how these coverages usually work in Texas, not advice about your policy; for that, read your declarations page and talk to your insurance agent or a licensed Texas attorney.

Your own PIP pays first, no matter who caused the crash

Texas Insurance Code requires every auto liability policy issued in the state to include personal injury protection unless a named insured rejects it in writing. The Texas Department of Insurance describes PIP as similar to medical payments coverage: it pays your and your passengers' medical bills, and it can also reimburse lost income and other nonmedical costs.

Two features make PIP especially useful in the first weeks. First, the statute says PIP benefits are payable without regard to fault, so it does not matter whether you, the other driver or nobody caused the crash. Second, it says the insurer must pay benefits as claims arise, no later than the 30th day after it receives satisfactory proof of the claim. The policy may set a deadline of at least six months after the accident for submitting your original proof of loss, so do not sit on PIP paperwork.

Many people do not know whether they have PIP. Check your declarations page or ask your agent. If you never signed a written rejection, it is likely on your policy.

Medical payments coverage and health insurance fill the next gaps

Medical payments coverage, often called MedPay, is optional. TDI explains that it pays your and your passengers' medical bills, and also pays if you are hurt while riding in someone else's car or while walking or biking. Some drivers carry it in addition to PIP.

Your health insurance is still your health insurance after a car accident. Using it can keep providers from sending bills to collections while the injury claim is pending, and providers often accept the plan's negotiated rate. The trade-off is that many health plans, and Medicare, expect to be reimbursed from any injury settlement for what they paid on accident-related care. That is normal, and a good injury lawyer verifies and negotiates those reimbursement claims at the end of the case. I explain how that works in my guide to what an injury lawyer costs and what you take home.

The at-fault driver's liability coverage pays at the end

Texas is a fault-based state: the driver who caused the crash, through their liability insurer, is responsible for the harm. Texas Transportation Code sets the minimum liability coverage at $30,000 for injury to or death of one person, $60,000 for two or more people, and $25,000 for property damage in one collision. TDI calls this 30/60/25 coverage.

Those minimums matter more than people expect. If you have a serious injury, $30,000 can be used up quickly by emergency care, imaging and a few months of therapy, before anyone accounts for lost income or the effect on your life. The other driver may carry more, but you cannot assume it. Also remember that the liability insurer is paying to close the whole claim, so it pays once, through a settlement or judgment, rather than bill by bill. That is why the coverage in your own policy carries you through the months in between.

When the other driver has no insurance, or not nearly enough

Uninsured and underinsured motorist coverage (UM/UIM) exists for exactly this situation. The Insurance Code requires insurers to include it in auto liability policies unless a named insured rejects it in writing. TDI explains that it pays if you are hit by someone who did not have insurance or did not have enough to pay your medical and car repair bills, and that it also applies in hit-and-run accidents. TDI also notes that a deductible applies to UM/UIM claims.

A UM/UIM claim is a claim against your own insurer, but it is not a friendly conversation just because it is your company. Your insurer steps into the shoes of the at-fault driver and can dispute fault and the value of your injuries the same way the other side would. Your policy also has its own notice and cooperation requirements. If you are heading into a UM/UIM claim with a significant injury, it is worth getting advice first.

Rideshare crashes: what the driver's app was doing matters

Crashes involving Uber, Lyft and other rideshare vehicles have their own insurance rules in Texas. Under the Insurance Code, while a driver is logged in to the app and available but not on a ride, the policy must provide at least $50,000 per person and $100,000 per incident for bodily injury, plus $25,000 for property damage. While the driver is engaged in a prearranged ride, the policy must provide a total aggregate liability limit of at least $1 million per incident. Both phases also require UM/UIM and PIP coverage where the general Texas rules call for them.

If the driver was not logged in at all, the driver's personal auto policy is generally the starting point. Whether you were the passenger, the rideshare driver or someone in another car, the first questions are the same: what was the app status at the moment of the crash, and which insurer is responsible for that phase. Screenshots of the ride receipt and app history are worth saving right away. If you drive for a rideshare company yourself, check whether your personal policy excludes rideshare use and whether you have added a rideshare endorsement, because the gaps between personal and company coverage are where a driver can end up without coverage for their own injuries.

Commercial trucks and company vehicles

When the at-fault vehicle belongs to a business, such as a delivery van, a service truck or an 18-wheeler, the company and its commercial insurer are often part of the claim along with the driver. Commercial policies frequently carry higher limits than personal ones, and more than one policy may apply when several companies are involved, such as a trucking company and a cargo loader. In the meantime, your own PIP and health coverage still pay first, exactly as they would after a crash with a private car. Identifying every policy that might apply is part of building the claim, and it is easier to do early, before records are lost.

Vehicles owned by a city, county or other public body are a different case. Claims against government entities have their own limits on what can be recovered, and they can require written notice of the claim within months of the crash, not years. If a city truck, a public bus or a county vehicle hit you anywhere in Dallas County or the surrounding area, find out quickly which notice rules apply, because missing one can end a claim before it starts. Your own PIP and health coverage still pay your bills in the meantime.

Check your own coverage before the next crash

The best time to think about this is before you need it. Many drivers rejected PIP or UM/UIM years ago to save on premiums, sometimes without realizing what they signed, and find out only after a crash. Pull out your declarations page and look for four things: whether PIP is on the policy and in what amount, whether UM/UIM is on the policy and whether its limits match your liability limits, whether you carry MedPay, and what your liability limits are. Then ask a licensed insurance agent to explain your options; a property and casualty agent such as Aaron Husman can walk you through what each change would cost.

If you have already been hurt and are trying to work through these coverages on your own, my guide to handling your own injury claim in Texas explains which situations are manageable and which are not. And if you are worried that being partly at fault means nobody will pay, read the Texas injury myths I correct most often before you assume the worst.

How we sort out the bills while your case is open

When clients hire us, one of the first things we do is map every source of coverage: your PIP and MedPay, your health plan, the at-fault driver's liability policy, any commercial or rideshare policy, and your UM/UIM coverage. We help you submit the claims that should be paid now, and we track the bills and liens that will have to be resolved when the case ends, so that the final numbers are accurate and nothing comes back to you later.

Then we build the claim against the responsible party, take over the insurer's calls, negotiate, and file suit if a fair settlement is not offered. For personal injury claims, there is no attorney fee unless we recover compensation, and the first consultation is free. We represent people throughout the Dallas–Fort Worth area and Kaufman County, and our phone line is answered around the clock.

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