Medical care for people injured in traffic accidents

If you have come this far, you are probably wondering which medical center you can go to to treat yourself for the injuries you have suffered in a traffic accident and who will pay for this medical assistance. In this entry we will try to give you these answers and you will also be able to locate the health centers closest to your home with our search engine .

Who pays for health care resulting from a traffic accident?

Our legal system guarantees citizens public, free and universal healthcare . That is why we believe that Social Security takes care of all the health problems that we may have, even those caused by a traffic accident. However, there are certain activities (such as driving motor vehicles) that, due to the risk created, require the contracting of compulsory insurance for their practice.

It should also be noted that article 83 of the General Health Law recognizes the right of the Public Administrations to claim from the responsible third party, and obliged to pay, the cost of the health services provided in those cases of compulsory insurance.

Thus, any person who has suffered injuries as a result of a traffic accident has the right to receive adequate health treatment, either in Public or Private health centers. The cost of said assistance will not be borne by Social Security, but must be borne by an insurance company (or the Insurance Compensation Consortium).

What are the Health Assistance Agreements: Public and Private?

At this point and given the large number of injured people resulting from traffic accidents who require health care, the need to invoice said health care provided, as well as the enormous complexity of liquidation in relation to the determination of civil liability, evidenced the need to establish some kind of mechanism that would facilitate the entire flow of procedures and claims that arose between healthcare centers and insurance companies (and the Insurance Compensation Consortium).

Several decades ago, the first agreements were signed that began to regulate various aspects of this matter. Over the years and up to the present, these Agreements have been expanded, extended and perfected until reaching a high degree of application. The Agreements contribute to the simplification and streamlining of the administrative procedures and procedures that arise between the assistance centers and the insurance entities (and the Insurance Compensation Consortium) adhered to said Agreements.

Of the various existing Agreements, due to their broad scope of application, we must pay special attention to those that affect the Public and Private sectors of health care, and whose versions in force at present are:

  • Public healthcare agreement derived from traffic accidents for the years 2017, 2018, 2019 and 2020. Here you can see the Public healthcare agreement derived from traffic accidents.
  • Framework agreement for health care derived from traffic accidents for the years 2019/2022 (Private Sector). Here you can see the Agreement on health care derived from traffic accidents (Private sector) .

After this already long experience in the application of said Agreements, the following advantages have been evidenced:

The injured are treated without having to bear the cost of the health care received. 

* The assistance centers charge immediately, since the Agreements establish objective criteria for the payment of their billing.

* Insurance companies thus acquire certainty about the health costs that constitute an important part of the accident rate.

Who has the obligation to pay according to the Health Assistance Agreements?

Regardless of who was responsible for causing the damage, the person liable to pay according to the Agreements (Public and Private) will be determined objectively, taking into account the following assumptions:

Claims involving a single vehicle : The insurance company (or the CCS) undertakes to pay the health benefits required by the victims of the claim, except for the driver of the vehicle. In the Public Health Assistance Agreement, the expenses derived from the health care provided to the driver are included with the limit set out in the economic conditions of the Agreement (up to €9,899 for the 2018 financial year).

Claims involving more than one vehicle : In these claims, each insurance company (or the CCS) will pay the health benefits corresponding to the victims occupying the vehicle they insure and those of the respective driver.

Injuries to third parties who are not users of the intervening vehicles : Health care benefits for third parties who are not users of the intervening vehicles (eg: pedestrians), will be paid by the insurance company (or the CCS) of the vehicle causing the injuries.

What health centers can I go to?

After having suffered injuries in a traffic accident, it seems clear that the first stage within the care circuit is that provided in the Emergency services of any health center (Public or Private). If after said initial provision it is necessary to continue the corresponding health treatment, it is at this point where we must pay special attention in which center we will carry it out. Several considerations in this regard:

  • Public Health Center: The usual collapse in which public health is immersed means that the follow-up of the corresponding treatment in said area is excessively prolonged in time, making it ineffective in terms of achieving the rapid and correct health of the injuries suffered. . This makes it advisable to analyze other possibilities.
  • Health Center offered by the insurance company: The insurance company of the vehicle in which you were traveling, or that of the vehicle responsible for the accident, can offer you the possibility of going to certain health centers that they may have arranged and in which they will offer you the corresponding treatment. Obviously, in this case, the cost must be borne by the entity that refers you to these centers.
  • Private Health Center of your choice: Another possibility is that the injured person continues the treatment in the health center that he or she deems appropriate. Here we must consider that the cost must be assumed initially by the injured person and proceed to his subsequent claim to the insurance company of the vehicle responsible for the accident. In the event that the same injured party was also responsible for the accident, and therefore the aforementioned claim did not proceed, it would be necessary to comply with the provisions of the corresponding Automobile Insurance contract, to analyze the viability of the origin or not of your refund.
  • Health Center adhered to the Private Health Assistance Agreement (UNESPA): Lastly, it is possible that the injured person chooses to continue the treatment of their injuries in any of the health centers adhered to the Private Health Assistance Agreement. In this case, it will be the chosen center itself that will require the corresponding authorization from the insurance company and will proceed to bill the cost of the treatment carried out to said company according to the regulations established in the Agreement itself. In this case, the injured party must not advance any amount for the healthcare benefit received . Although here you can also  see the list of all the centers adhered to the Private Health Assistance Agreement With our medical center search engine, it will be easier for you to locate the one that best suits you near your home.

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