Why the at-fault insurer will not pay as you go
Liability insurance is not health insurance. It responds to a claim for damages once, when that claim is resolved, in a single payment that covers medical expenses, lost earnings and non-economic damages together.
There is a structural reason for this. Until treatment concludes, nobody knows the total value of the claim. An insurer paying bills along the way would be settling the case in installments without knowing the final number.
The practical consequence is that between the crash and the settlement — often many months — someone else is paying, and that someone is you, your insurers, or your providers. Which one it is affects your net recovery significantly.
MedPay is the most overlooked coverage in California
Medical Payments coverage is optional in California and many drivers carry it without knowing. It typically ranges from one thousand to ten thousand dollars, pays regardless of who caused the crash, and usually applies with no deductible.
It also covers passengers in your vehicle and, in many policies, covers you as a pedestrian or cyclist struck by a car. Using it does not raise your rates for a not-at-fault collision, because the claim is not a liability claim against you.
Your insurer may assert a right of reimbursement from your eventual settlement. Even where it does, MedPay solves the immediate problem: getting treated now, without a gap in the record, while liability is still being argued about.
Health insurance liens and why the number is negotiable
If your health plan pays for accident-related treatment, it will typically assert a right to be reimbursed out of your recovery. This is normal and it is enforceable. What is not fixed is the amount.
Reimbursement claims are commonly reduced, particularly where the available liability limits are low relative to the total medical bills, or where a full reimbursement would leave the injured person with little or nothing. Different plan types operate under different rules, and those rules shape how much leverage exists.
This is unglamorous work that happens at the end of a case and it routinely changes the net figure by thousands of dollars. It is also the part of the process most people never see, because it happens after the headline settlement number has already been agreed.
Treating on a lien — the tradeoff
Many California providers will treat injury patients on a lien, agreeing to be paid from the settlement rather than at the time of service. For someone with no health insurance and no MedPay, this is often the only way to get consistent care.
The tradeoff is that lien-based billing is not negotiated down by an insurer at the time of service the way in-network health insurance rates are. The balance that arrives at settlement can be substantially larger than what a health plan would have paid for identical care.
That does not make lien treatment wrong. It makes it a decision worth making deliberately, with an understanding of how it affects the final arithmetic — not a decision made by default because nobody explained the alternatives.
When the at-fault driver has no insurance, or not enough
California's minimum liability limits rose to thirty thousand per person and sixty thousand per accident on January 1, 2025, up from fifteen and thirty. That is still frequently less than the cost of a serious injury.
Uninsured and underinsured motorist coverage on your own policy, governed by Cal. Ins. Code § 11580.2, is what fills that gap. UM applies when the at-fault driver has no coverage; UIM applies when their limits are exhausted and your damages exceed them.
Rideshare collisions have their own layer. Cal. Pub. Util. Code § 5433 was amended by SB 371 effective January 1, 2026, reducing required uninsured motorist coverage during certain rideshare periods from one million dollars to sixty thousand. Many sites still describe the old figure. If your crash involved an Uber or Lyft driver, which period they were in determines what coverage applies.
