Updated September 3, 2026
In the short term, you and your own coverage do. The at-fault driver's insurance company does not pay your medical bills as they come in. It pays once, at the end, as part of a settlement or judgment that covers all of your losses. Until then, the bills are handled by your health insurance, your own auto policy's medical payments coverage, or a provider willing to wait, and each of those may have a claim on the settlement when it arrives. Here is how the pieces fit.
The at-fault driver's insurer pays at the end
A liability insurer has no obligation to pay your providers while the claim is open, and it usually will not. Paying bill by bill would mean conceding fault and would leave the insurer no room to argue about which treatment was reasonable. Instead, medical expenses become one component of the demand, and the settlement is paid as a lump sum. That is why a claim cannot be settled sensibly until treatment is done or the future course of care is known.
Your health insurance pays first
If you have health insurance, use it. Your plan pays your providers at its contracted rates the same way it would for any other injury, and being insured does not let the at-fault driver off the hook for that care. What it does change is the figure: under the Howell rule, covered below, you recover what your plan actually paid, not the amount billed. Most plans have a reimbursement or subrogation right, meaning they can ask to be repaid from your settlement for crash-related care. California limits how much certain health plans can take back and requires them to share in the cost of obtaining the recovery (Civil Code section 3040), though plans governed by federal law can operate under different rules. The reimbursement is negotiated and paid out of the settlement before the balance reaches you.
MedPay on your own auto policy
Medical payments coverage, called MedPay, is an optional part of a California auto policy. It pays medical bills for you and your passengers up to its limit regardless of who caused the crash, with no fault determination. Check your declarations page; many people carry it without knowing. Some policies ask to be repaid from a later settlement, so read the language, but MedPay is often the fastest money available after a crash.
Uninsured and underinsured motorist coverage
If the at-fault driver had no insurance, or not enough, your own uninsured and underinsured motorist coverage steps in (Insurance Code section 11580.2). California insurers must offer it, and it is part of your policy unless you declined it in writing. Underinsured coverage pays the difference between the other driver's limits and your own, after the other driver's policy is paid out. These claims are made against your own insurer and follow the timing rules in the policy and the statute.
Treating on a lien
When you have no health insurance, or a specialist is out of network, some providers will treat on a lien or a letter of protection: they agree to wait for payment until the case resolves, in exchange for a promise that they will be paid from the settlement. This keeps care going, but the full billed amount is owed to that provider at the end, and it comes out of your share. Lien balances are commonly negotiated at settlement, and the reductions vary.
Hospital liens
A hospital that treated you for crash injuries has a statutory lien on any recovery from the at-fault party (Civil Code section 3045.1). The hospital must give written notice to the other side, and the law caps how much of the recovery the lien can take, but it means the hospital can be paid directly out of the settlement rather than waiting for you to pay.
Medi-Cal and Medicare
If Medi-Cal paid for any of your care, the Department of Health Care Services has a statutory right to be repaid from the settlement, and it must be notified of the claim. Medicare has a similar right under the federal Medicare Secondary Payer law, and settling without resolving Medicare's conditional payments can create problems for you and for the insurer. Both programs reduce their claims by a share of attorney fees and costs, and both are resolved before disbursement.
What you can recover: the Howell rule
The California Supreme Court held in Howell v. Hamilton Meats (2011) that an injured person's recovery for past medical expenses is limited to the amounts actually paid or still owed, not the amounts a provider originally billed. If a hospital billed a large sum but accepted a smaller contracted payment from your health plan, the smaller figure is what the claim rests on. This is why the way your bills were paid affects the size of the medical component, and why lien bills and insured bills are treated differently.
If you do nothing
Waiting for the other driver's insurer to pay is the most common mistake. The provider's contract is with you, not the other driver, and a bill that goes unpaid long enough goes to collections regardless of fault. Recent California law limits how medical debt can be reported to credit bureaus, but collection activity still happens, and the debt does not go away when the claim settles unless someone pays it. Give every provider your health insurance and MedPay information at the first visit, keep every bill and explanation of benefits, and track who has been paid and who is waiting.
Sorting out which coverage pays, who gets repaid, and what is left is a large part of what settling a claim involves. If the bills are piling up and the answers are unclear, a free consultation with a Long Beach personal injury attorney costs nothing and settles what your options are. For the decision that usually comes next, see our guide on whether to accept the first offer.
This page is general information for Long Beach residents, not legal advice about any specific situation. Agency fees and procedures change; confirm details with the agency before you rely on them.
