Catastrophic Accident Insurance: How Does It Work?

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A catastrophic injury, like a spine injury, might mean more than $4 million in past and future medical bills. Normally, health insurance companies refuse to pay injury-related costs, citing liability concerns. There’s a chance that someone else might pay these bills, like a negligent driver’s insurance company. However, certain catastrophic accident insurance providers might write checks in these situations.

The potentially good news about Catastrophic Accident Insurance is that it could enable an accident victim to bypass the legal system and pay medical bills as they come due. The bad news is that an Edwardsville personal injury attorney has no chance to obtain additional compensation for these victims. This additional compensation usually includes money for additional economic losses, such as lost wages, and noneconomic losses, such as pain and suffering.

Plan Details

In general, CAI plans are high-deductible, low-cost plans with either very high or unlimited coverage ceilings. By law, these plans must also pay for three primary care visits a year and certain immunizations, screenings, and other preventative services.

Many health insurance plans only apply to limited situations. But most Catastrophic Accident Insurance plans cover almost any type of injury that a group health or other plan refuses to cover. So, for many people, CAI is a good supplemental plan.

Catastrophic Accident Insurance benefits are typically no-fault benefits. Even if you were partially responsible for the accident, CAI policies usually still pay. In contrast, to obtain the aforementioned damages, an attorney must prove the other party was negligent. Essentially, negligence is a lack of ordinary care.

[LEARN MORE]: How Long After an Injury Can You Sue?

Do I Qualify for Catastrophic Accident Insurance?

Qualifying for CAI is usually the tricky bit. Under the Affordable Care Act, you may buy Catastrophic Accident Insurance if you are under 30 or qualify for a hardship exemption. Some examples include recent serious financial issues, such as:

  • Homelessness,
  • Flood, fire, or other casualty losses,
  • Utility shut-off notice,
  • Eviction or foreclosure proceedings,
  • Bankruptcy filing,
  • Substantial unpaid medical bills, or
  • Medicaid ineligibility.

Domestic violence and the death of a close family member might also serve as hardship exemptions in some situations.

A CAI policy could pay some bills resulting from a catastrophic injury accident, but a lawyer is usually a better option. For a free consultation with an experienced personal injury attorney in St. Louis, contact Walton Telken, LLC. We do not charge upfront legal fees in these matters.


Is health insurance worth it?

Yes, especially if you have dependents, or you yourself have a pre-existing condition.

How bad do you get hurt in a car crash?

Common car crash injuries include excessive blood loss and head injuries. These wounds are often fatal.

How does a lawyer win money in court?

Attorneys must prove negligence by a preponderance of the evidence, or more likely than not.

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