What should I do if I have used my medical insurance card for a traffic accident?

Then you have to discuss with the party that made the trouble, generally speaking, if you use a medical insurance card, the insurance company will not be responsible for compensating for the medical expenses.

Interim Measures for Advance Payment of Social Insurance**:

Article 2 Employees or residents (hereinafter referred to as individuals) participating in basic medical insurance are injured or sick due to the tortious acts of a third party, and their medical expenses shall be borne by the third party in accordance with the determined size of the responsibility. The medical expenses exceeding the third party's liability shall be paid by the basic medical insurance** in accordance with national regulations.

If the third party does not pay the medical expenses that should be paid by the third party in the provisions of the preceding paragraph or the third party cannot be determined, when the medical expenses are settled, the individual may apply in writing to the social insurance agency in the place where the insurance is insured for basic medical insurance** to pay in advance, and inform the cause of his injury or illness and the third party's failure to pay the medical expenses or the inability to determine the third party.

Article 3 After receiving the application submitted by the individual in accordance with the provisions of Article 2, the social insurance agency shall pay the corresponding part of the medical expenses in advance in accordance with the provisions of the overall regional basic medical insurance.

Article 4 Where an individual's injury or illness is determined to be a work-related injury due to a third party's tortious act, and the third party does not pay the medical expenses for the work-related injury or the third party cannot be identified, the individual or his close relatives may apply in writing to the social insurance agency for work-related injury insurance ** to pay in advance with the work-related injury determination decision and relevant materials, and inform the third party of the non-payment or the inability to determine the third party.

Article 11 Where an individual has already received medical expenses, work-related injury medical expenses or work-related injury insurance benefits from a third party or an employer, he or she shall take the initiative to return the part of the amount paid in advance to the third party or the work-related injury insurance benefits paid in advance to the basic medical insurance** or work-related injury insurance**, and the social insurance agency shall not seek compensation from the third party or the employer.

If an individual refuses to return it, the social insurance agency may deduct the amount that should be refunded from the relevant benefits paid in the future, or file a lawsuit with the people's court.

Isn't a traffic accident not reported?

1. Can I use a medical insurance card for traffic accidents?

1. Medical insurance cards cannot be used for traffic accidents.

1) In the event of a traffic accident, the insurance company will compensate within the limit of the insured amount;

2) If the insurance limit is exceeded, the insufficient part of the insurance shall be made up by the third party in the case of purchasing a third party's sail;

3) If the third party is not enough, the excess part shall be made up by the insured himself.

2. Legal basis: Article 27 of the Social Insurance Law of the People's Republic of China.

Individuals who participate in the basic medical insurance for employees, when they reach the statutory retirement age, the cumulative contributions reach the number of years prescribed by the relevant laws, and the basic medical insurance premiums will not be paid after the retirement period, and the basic medical insurance benefits shall be enjoyed in accordance with the relevant laws and regulations; If the time limit prescribed by the relevant law has not been reached, the fee may be paid up to the time limit prescribed by the relevant law.

2. What should I do after a traffic accident?

1. Accept the report: After receiving the report from the public security traffic management department or others, it shall file the case in accordance with the scope of jurisdiction;

2. On-site processing: After accepting the case, the public security traffic management department immediately dispatched personnel to the scene to rescue the injured and property, investigate the scene, and collect evidence;

3. Determination of responsibility: On the basis of ascertaining the facts of the traffic accident, the public security traffic management department shall determine the traffic accident responsibility of the parties according to the causal relationship between the violation of the accident and the traffic accident, and the size of the role;

4. Ruling and punishment: The public security traffic management department shall, in accordance with the relevant regulations, give warnings, fines, suspensions, revocations or penalties to the responsible persons;

5. Mediation of compensation for damages: For the compensation of personal injuries and deaths caused by traffic accidents, the corresponding compensation ratio shall be divided according to the relevant provisions and compensation standards, and the public security traffic management department shall convene the parties to mediate. The two parties agreed to reach an agreement that the mediation personnel of the accident section would prepare and issue a mediation letter for damages.

After the traffic accident, if the injured party uses medical insurance to see a doctor, it will not affect the traffic accident claim, and the part that has been reimbursed needs to be returned to the relevant department of medical insurance at a later stage. Generally speaking, social insurance (including mutual medical care) does not reimburse traffic accidents, and can only be compensated by the party responsible for the accident, but medical insurance can reimburse part of the drug money. All expenses incurred due to ** shall be borne by the insurance company within the limit, and if the limit is exceeded, the excess part shall be compensated by the responsible person.

However, in the following cases, you can find medical insurance to reimburse part of the medical expenses:

1. If you bear part of the responsibility in a traffic accident, the medical expenses you bear can be reimbursed by medical insurance.

2. The medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance.

Under normal circumstances, because traffic accidents are personal injuries caused by others, it is generally not possible to use a medical insurance card**. If the medical insurance card is used for **, and the other party subsequently pays the corresponding medical expenses, the injured person should also return the part that has been reimbursed by the medical insurance to the relevant departments of the medical insurance again, otherwise, it may constitute insurance fraud.

Legal basis

Interpretation of the Supreme People's Court on Several Issues Concerning the Application of Law in the Trial of Cases of Compensation for Damages in Road Traffic Accidents

Article 16. If a motor vehicle that has purchased both compulsory third-party liability insurance for motor vehicles (hereinafter referred to as "compulsory traffic insurance") and commercial third-party liability insurance (hereinafter referred to as "commercial third-party insurance") causes damage caused by a traffic accident, and the parties sue both the infringer and the insurance company, the people's court shall determine the liability for compensation in accordance with the following rules:

1) The insurance company that underwrites the compulsory traffic insurance shall first compensate within the limit of liability;

2) The shortfall shall be compensated by the insurance company that underwrites the commercial third-party insurance in accordance with the insurance contract;

Where the infringed party or their close relatives request that the insurance company that underwrites the compulsory traffic insurance give priority to compensation for mental damages, the people's court shall support it.

Social Insurance Law of the People's Republic of China

Article 30 The following medical expenses are not included in the scope of payment of basic medical insurance:

1) It should be paid out of work-related injury insurance**;

2) It shall be borne by a third party;

3) It should be borne by public health;

4) Seeking medical treatment outside the country.

Medical expenses shall be borne by the third party in accordance with the law, and if the third party does not pay or the third party cannot be determined, the basic medical insurance shall pay in advance. After the basic medical insurance** is paid in advance, it has the right to recover from a third party.

In a traffic accident, unless the perpetrator escapes, it is not possible to guess the social health insurance card.

On July 1, 2011, China officially promulgated and implemented the "Social Insurance Law of the People's Republic of China", which stipulates that the following medical expenses are not included in the scope of payment of basic medical insurance**: should be paid from work-related injury insurance**; It should be borne by a third party; should be borne by public health; Those who seek medical treatment outside of China.

Since traffic accidents are mostly accidents with third-party liability, medical insurance policies in various places stipulate that traffic accidents do not belong to the scope of medical insurance, that is, they cannot use medical insurance spike cards, and they need to pay in advance for the injured or the responsible party or the insurance company, which will be borne by the traffic police in proportion to the responsibilities. In this way, on the one hand, it can ensure the reasonable use of medical insurance** and benefit the insured. At the same time, on the other hand, it also avoids duplicate reimbursement and prevents the victim from receiving compensation that exceeds the cost spent.

Extended reading: [Insurance] How to buy, which one is better, teach you to avoid these insurance"pits"

Summary. After paying the medical expenses from the medical insurance pool, the parties can still claim compensation from the infringer. The medical insurance co-ordination ** belongs to all insured persons, and is centrally managed by social insurance institutions and uniformly adjusted.

The injured person is entitled to medical insurance benefits only after fulfilling the corresponding payment obligations for many years, and the third party (tortfeasor) cannot be exempted from liability because the victim enjoys social security, so the part of the medical insurance payment cannot offset the tort liability of the tortfeasor of the traffic accident.

Legal basis: Article 28 of the "Social Insurance Law" in line with the basic medical insurance drug list, diagnosis and treatment items, medical service facilities standards and emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance **.

What should I do if I use my medical insurance card in a traffic accident?

After the medical expenses are paid from the medical insurance Xiansheng Bank, the parties can still claim compensation from the infringer. The medical insurance co-ordination ** belongs to all insured persons, and is centrally managed by social insurance institutions and uniformly adjusted. The injured person is entitled to medical insurance benefits only after fulfilling the corresponding payment obligations for many years, and the third party (tortfeasor) cannot be exempted from liability because the victim enjoys social security, so the part of the medical insurance payment cannot offset the tort liability of the tortfeasor of the traffic accident.

Basis: Article 28 of the Social Insurance Law Article 28 of the basic medical insurance brothers' banquet drug list, diagnosis and treatment items, medical service facility standards, as well as emergency and rescue medical expenses, in accordance with national regulations from the basic medical insurance **.

Is this a work-related injury during your commute time?

The traffic accident did not use medical insurance at the beginning, but after being discharged from the hospital, one of the examinations was covered by medical insurance, so can it still be reimbursed?

Well, that doesn't affect normally.

Is there a police filing?

The information is complete. Well, then just follow the accident process.