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Who pays medical bills after a car accident in Texas? PIP, MedPay, health insurance and liens

How personal injury protection, medical payments coverage, health insurance, the other driver's liability coverage and Texas hospital liens fit together after a car crash, explained with official sources as of October 2026.

7 min readPublished October 22, 2026Last updated October 22, 2026Edited by Joseph Budzinski, CTO, InjuryClaimGuide

The short answer

In Texas, medical bills after a car crash can be paid from several places, and each one follows its own rules: your own personal injury protection (PIP) or medical payments coverage, your health insurance, the at-fault driver's liability insurance, and in some cases uninsured or underinsured motorist coverage. PIP benefits are payable without regard to fault (Ins. Code §1952.155), while the other driver's liability coverage pays for injuries that driver is responsible for. A hospital can also hold a lien on a claim against the person responsible for the crash (Prop. Code §55.002).

This guide explains how those pieces fit together in general terms, with the official text linked for each one. It is general informational guidance and is not legal advice; it does not say who should pay in any particular case and puts no number on any claim.

Key facts (as of 2026-10-22)

  • PIP is included unless rejected in writing. An insurer may not issue a Texas auto liability policy without PIP unless an insured named in the policy rejects it in writing (Ins. Code §1952.152).
  • PIP does not depend on fault. Required PIP benefits are payable without regard to who caused the collision (§1952.155).
  • PIP payment timing. An insurer must pay PIP benefits as claims arise, but not later than the 30th day after it receives satisfactory proof of a claim (§1952.156).
  • Medical payments coverage is separate. The PIP law does not affect the offering of medical payments coverage (§1952.161); the Texas Department of Insurance (TDI) describes it as paying medical bills for you and your passengers (TDI, Auto insurance guide).
  • Minimum liability limits. A driver's liability coverage must be at least $30,000 for bodily injury to one person and $60,000 for two or more people in one collision (Transp. Code §601.072).
  • Hospital liens. A hospital has a lien on the claim of a person admitted within 72 hours of an accident attributed to another person's negligence (Prop. Code §55.002).

What does PIP pay for after a Texas car accident?

The Insurance Code defines personal injury protection as policy provisions that pay the named insured, members of the insured's household, and any authorized driver or passenger of the insured's vehicle, including a guest, for reasonable expenses that arise from an accident and are incurred within three years of it. Those expenses include necessary medical, surgical, x-ray, dental, ambulance, hospital, nursing and funeral services; replacement of lost income for an income producer; and, for someone who was not earning income, reasonable expenses for essential household services the injured person ordinarily performed (Ins. Code §1952.151).

A few other rules in the same subchapter:

  • The law does not require an insurer to provide more than $2,500 in PIP per person in the aggregate; a policy can carry a higher limit (§1952.153).
  • A policy may set a period of not less than six months after the accident within which the original proof of loss must be presented (§1952.156(b)).
  • PIP benefits are payable without regard to other sources of medical, hospital or wage benefits (§1952.155(a)(2)).

Our PIP guide covers PIP in more detail.

What is medical payments coverage (MedPay)?

Medical payments coverage is a policy coverage rather than a coverage the Insurance Code requires. The PIP subchapter states that it does not affect the offering of medical payments coverage (Ins. Code §1952.161). TDI describes medical payments coverage as paying your and your passengers' medical bills, including when you are hurt while riding in someone else's car or while walking or biking, and describes PIP as similar but also paying for things like lost wages and other nonmedical costs (TDI, Auto insurance guide). Whether a policy includes medical payments coverage, and its limit, is shown on the policy's declarations page.

Does the other driver's insurance pay medical bills?

Liability insurance pays for injuries and damage the insured driver is responsible for. TDI describes liability coverage as paying the other driver's and passengers' medical bills and some other expenses when the insured caused the accident (TDI, Auto insurance guide). Texas sets minimum liability amounts of $30,000 for bodily injury to or death of one person and $60,000 for two or more people in one collision (Transp. Code §601.072); see our guide to Texas minimum auto insurance requirements.

A claim against another driver's liability policy depends on who was responsible for the crash, and Texas divides responsibility in percentages; see the Texas 51% rule, explained. Our guide to talking to the insurance adjuster covers what that process involves.

What if the other driver has no insurance or not enough?

Uninsured or underinsured motorist (UM/UIM) coverage protects insureds who are legally entitled to recover from owners or operators of uninsured or underinsured vehicles, and an insurer must include it unless an insured named in the policy rejects it in writing (Ins. Code §1952.101). TDI says that if the other driver's limits are not enough to cover all your medical bills, you can file a claim with your auto insurance company or your health insurance company, and the auto insurer will use PIP, medical payments or UM/UIM coverage to pay the difference (TDI, Auto insurance guide). See our UM/UIM guide.

Can health insurance pay for car accident injuries?

A health plan pays under its own terms. Many health plans include a contractual right to be repaid from a later recovery against the person who caused the injury. Civil Practice and Remedies Code chapter 140 allows an issuer of a health benefit plan to contract to be subrogated to, and to have a right of reimbursement from, the covered person's recovery for an injury caused by a third party, subject to the chapter's limits (CPRC §140.004). Chapter 140 does not apply to workers' compensation, Medicare, Medicaid, the state child health plan, or a self-funded plan subject to the federal ERISA law (§140.002(f)). Your plan documents state the terms that apply to your plan.

What is a hospital lien in Texas?

Property Code chapter 55 gives a hospital a lien on the cause of action or claim of a person who receives hospital services for injuries caused by an accident attributed to the negligence of another person, if the person is admitted to a hospital not later than 72 hours after the accident (Prop. Code §55.002). In general terms:

  • The lien attaches to the injured person's cause of action, to a judgment, and to money paid to resolve a claim for that injury (§55.003(a)).
  • It does not attach to a workers' compensation claim, or to the proceeds of an insurance policy in favor of the injured person other than liability insurance that protects the insured against loss caused by an accident (§55.003(b)).
  • The Code limits the amount of the lien (§55.004).
  • To secure the lien, the hospital must give the injured person notice and file written notice with the county clerk of the county where services were provided before money is paid because of the injury (§55.005).
  • A release of the claim is not valid against the lien unless the hospital's charges were paid as the Code describes or the hospital is a party to the release (§55.007).

Emergency medical services providers can hold a similar lien in some counties under the same chapter. Our guide to hospital and medical liens in Texas covers the lien rules in more detail.

What can you gather about medical bills after a crash?

It can help to keep these in one place:

  • Each medical bill and any explanation of benefits from a health plan
  • Your auto policy's declarations page, showing PIP, medical payments and UM/UIM coverage and their limits
  • Any written rejection of PIP or UM/UIM you signed
  • Any notice of a hospital or emergency medical services lien you receive
  • Records of missed work, if lost income is part of a PIP claim
  • Your medical records; see medical records in injury claims

Related Houston information

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Frequently asked questions

Does PIP pay medical bills in Texas no matter who caused the crash?
Texas Insurance Code §1952.155 makes benefits under the personal injury protection coverage required by Insurance Code chapter 1952 payable without regard to the fault or nonfault of the named insured or recipient in causing or contributing to the collision. What a particular policy pays, and up to what limit, depends on that policy.
Is PIP required on every Texas auto policy?
Under Insurance Code §1952.152, an insurer may not issue a Texas auto liability policy unless it provides personal injury protection coverage, but the coverage does not apply if any insured named in the policy rejects it in writing.
What is the difference between PIP and medical payments coverage?
The Texas Department of Insurance describes medical payments coverage as paying your and your passengers' medical bills, including when you are hurt while riding in someone else's car or while walking or biking. It describes PIP as similar, but also paying for things like lost wages and other nonmedical costs. Your policy states which coverages you have.
Can a hospital put a lien on a car accident claim in Texas?
Under Property Code §55.002, a hospital has a lien on the cause of action or claim of a person who receives hospital services for injuries caused by an accident attributed to the negligence of another person, if the person is admitted to a hospital not later than 72 hours after the accident. To secure the lien, the hospital must give notice and file written notice with the county clerk before money is paid (§55.005).
Can health insurance be used for car accident injuries in Texas?
The Texas Department of Insurance says that if the other driver's limits are not enough to cover all your medical bills, you can file a claim with your auto insurance company or your health insurance company. A health plan's terms decide what it pays, and Civil Practice and Remedies Code chapter 140 governs contractual subrogation rights for many health plans.

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