Should I pay a rider's medical bills myself to keep the claim off my insurance?

Talk to your agent first. If the rider is on Medicare, a payment you make on your own can make your company the party that has to report the settlement to Medicare. CMS guidance gives the example of a company that settles without telling its insurer: that company owns the reporting, even when the amount falls inside its deductible. Physical injury settlements of $750 or less are below the reporting threshold for 2026.

Which policy pays when a rider falls on the van ramp?

It depends on the policy wording and your state, so report the fall to your commercial auto insurer and your general liability insurer and let them decide. Some auto policies carry medical payments coverage, which pays medical costs for passengers hurt in an accident. MTM's Pennsylvania provider agreement requires broad form coverage that includes loading and unloading, which is where boarding falls land.

Can the rider's lawyer find out how much insurance I carry?

In Florida, yes. On a claimant's written request, each liability insurer has 30 days to send a sworn statement naming the insurer and the insureds, giving the limits, listing any coverage defense it expects to raise, and attaching a copy of the policy. The insured, or the insured's agent, has to name every known insurer when asked. Other states handle policy disclosure differently.

How long does an injured rider have to file a lawsuit?

It depends on the state. Texas and Florida allow two years for a personal injury or negligence suit, and New York allows three years. The clock usually starts on the day of the injury. Keep the trip file, the incident report, and any video for at least that long, and longer if your broker contract or state program sets a longer records rule.

Does it matter that the rider refused to wear a seat belt?

Sometimes. Florida's belt statute lets a violation count as evidence of comparative negligence, and New York allows it to reduce damages when the defense pleads it. Georgia opened the door to seat belt evidence on fault and damages in 2025. Virginia bars it from motor vehicle injury suits entirely. Record every refusal on the trip, because the record is what the defense will need.

NEMT Passenger Injury Claim: Steps, Records, Deadlines

Q: Does Medicaid get repaid out of a rider's settlement?

Yes. Federal law makes every Medicaid enrollee assign to the state their right to payment for medical care from a liable third party. In Gallardo v. Marstiller (2022), the Supreme Court held that a state may seek that repayment from settlement money set aside for future medical care, not only past bills. Settlements with Medicaid riders have to account for the state's claim.

Many rider injury claims involve no crash at all

A rider can be hurt on a trip where the van never touched anything. The step is wet, the ramp edge catches a walker, a wheelchair strap is left loose and the chair tips on a turn, or the driver brakes hard at a yellow light. These claims turn on your own records, because there is often no police report and no other driver. The evidence is mostly what your company wrote down and saved.

Brokers already treat these moments as reportable. Modivcare’s incident form has to be filed within 24 hours for any transportation event, injury or not, and its checklist names loading and unloading, slips, trips, and falls inside and outside the vehicle, wheelchair and scooter securement, and harsh braking. That list doubles as a map of where claims come from.

What happened	Typical moment	What the adjuster will want
Fall at the step or curb	Boarding or leaving a van, often at the home or clinic door	The booked level of service, whether the driver was hands-on, step stool use, weather and lighting
Ramp or lift injury	A walker wheel or chair caster at the ramp edge, a hand caught in the lift	Lift inspection and maintenance records, the driver’s training on that lift
Securement failure	A chair shifts or tips under braking or on a turn	Which tie-downs and belts were used, the securement checklist, the driver’s training record
Hard stop	A seated rider thrown forward or out of the seat	Speed and braking data, dash camera video, whether the rider was belted
Left alone	A rider who needed a handoff left at a door or curb	The level of service on the manifest and the arrival and departure times

Prevention for each of these is covered in preventing rider falls and wheelchair securement standards. This guide covers what happens after someone is hurt.

The first day: care, the broker, and your insurers

The first day shapes how defensible the claim will be. Work through it in this order.

Offer medical care and write down the answer. Modivcare’s form asks whether the rider was asked about treatment and whether they accepted or refused, with a place for the rider or a representative to sign.
Report to the broker on its clock. MTM Health’s Rhode Island handbook puts every injury in Tier 1: a phone call right away, a written report within 24 hours, and a police report copy within five business days when police were called. A missed timeframe costs $500. The vehicle accident guide lists other brokers’ deadlines.
Handle any required drug test. WellTrans in Indiana requires the driver and any attendant to be tested right away whenever a member is injured in the provider’s care, with results sent within 72 hours.
Notify both liability insurers. A boarding fall can be argued as an auto claim or a general liability claim, so tell your commercial auto carrier and your general liability carrier the same day and let them sort out which one responds. Ask whether your auto policy has medical payments coverage, which pays medical costs for passengers injured in an accident.
Put a hold on the evidence. Modivcare’s form warns that incidents often turn into lawsuits and that losing relevant records afterward, even by accident, can bring significant court sanctions. Stop any automatic deletion of video, messages, and trip data for that day.
Take the driver’s written statement before the shift ends. Facts only: times, positions, what the rider said, what the driver did. The incident report template lays out the fields.

What the adjuster does with it

Once the claim is open, your insurer assigns an adjuster and a claim number. From that point, the adjuster is the one who talks to the rider, the family, or their lawyer. Your job is to supply records quickly and keep your staff from negotiating on their own.

Expect the adjuster to ask for three things early: a recorded statement from your driver, the trip records for that leg, and the driver’s file. Your own insurer taking a statement is part of the claim. If anyone else asks your driver for a recorded statement, including the rider’s insurer or an investigator, send them to your adjuster.

Coach drivers on a few rules for the weeks after an injury:

Do not talk about fault with the rider or family, and do not promise that the company will pay.
Stay polite on later trips with the same rider, and report any comment about the injury to the office.
Never change or add to a trip note after the fact. A late edit looks like a cover-up even when it is a correction. Write a new, dated note instead.

The adjuster will also check your policy against the facts. If the insurer writes that it is handling the claim while reserving its rights on coverage, read that letter with your agent the day it arrives.

When a lawyer takes the case

A letter from the rider’s attorney usually does three things: announces the representation, asks you to preserve evidence, and asks for insurance information. Forward it to your adjuster the day it arrives.

Preservation letters list what the lawyer expects to exist: video, GPS data, dispatch messages, the driver’s file, inspection and maintenance records. Treat the list as a floor, not a ceiling. Anything that existed on the day of the injury and was later deleted can be held against you.

Some states give the claimant a right to your coverage details before any suit is filed. In Florida, each liability insurer must answer a claimant’s written request within 30 days with a sworn statement naming the insurer and each insured, the limits, any coverage defense the insurer expects to raise, and a copy of the policy, including excess or umbrella coverage. The insured or the insured’s agent must also name every known insurer when asked.

Medical bills: Medicaid and Medicare come first in line

Many NEMT riders are on Medicaid, and many are on both Medicaid and Medicare. Both programs expect to be repaid from any injury recovery, and that changes how a settlement is written.

Medicaid. Federal law makes each Medicaid enrollee assign to the state the right to payment for medical care from any liable third party. In Gallardo v. Marstiller, decided in June 2022, the Supreme Court held that a state may seek that repayment from settlement payments allocated to future medical care, not just past bills. A settlement that ignores the state’s claim does not end the matter. The third-party liability entry explains the payment order.

Medicare. Liability insurers, and businesses paying claims themselves, must report injury settlements with Medicare beneficiaries to CMS under the Section 111 program. For 2026, CMS kept the threshold for physical trauma liability settlements at $750, so smaller payments do not have to be reported. CMS counts a business’s deductible as self-insurance. Its own example is a company that settles a claim without telling its insurer: that company becomes responsible for the report, whether the amount falls inside the deductible or above it. That is a strong reason not to pay a rider quietly out of pocket.

How a demand is valued

When the rider’s treatment levels off, their lawyer sends a demand: the medical bills and records, any lost income, a description of pain and limits on daily life, and a number, often with a deadline to respond. The adjuster weighs it against two things: who was at fault, and what the claim would be worth in court.

The standard of care matters first. Some states hold anyone who carries passengers for pay to a stricter duty than an ordinary driver; California’s is written into its Civil Code. The NEMT liability guide covers that duty.

State fault rules shape the answer too. Here are examples from three large NEMT states.

State	Time to sue	Rider’s own share of fault
Texas	Two years for personal injury	A claimant more than 50 percent responsible recovers nothing
Florida	Two years for negligence	A party more than 50 percent at fault for their own harm recovers nothing, outside medical negligence cases
New York	Three years for personal injury	Most injury suits keep pure comparative fault, so damages shrink by the rider’s share. A May 2026 amendment bars recovery in motor vehicle injury suits under the state’s no-fault insurance article when the claimant’s fault exceeds the defendants’

Seat belt use can matter too, and states disagree sharply. Florida’s belt statute lets a violation count as evidence of comparative negligence, but not as negligence in itself. New York allows it to reduce damages when the defense has pleaded it. Georgia’s 2025 tort reform (SB 68) made non-use admissible on fault and able to reduce a recovery. Virginia keeps it out of motor vehicle injury suits entirely, down to any comment by counsel. The seat belt guide covers what each state requires of riders.

The records that settle claims

Claims are settled on records made the day of the trip, often more than a year later. Before an injury ever happens, make sure each trip leaves these behind:

The manifest line. The booked level of service (curb-to-curb, door-to-door, hand-to-hand), the mobility device, and any notes about the rider.
Times and route. When the driver arrived, when the rider boarded and got off, and the GPS path in between. Speed and braking data from a telematics unit or camera can confirm or rule out a hard-braking story.
The driver’s statement and signature records. The rider’s signature at pickup or drop-off shows who was present.
Vehicle condition. The pre-shift inspection for that van and the lift and securement maintenance log.
The driver’s file. Training certificates, driving record, and background checks, current on the day of the trip.
Video. Interior and road-facing footage, saved before the camera loops over it. Dash cams in NEMT vans covers retention.
Every report you sent. Copies of the broker report and insurer notice with the date and time each went out.

Keep the full file for at least the longest lawsuit deadline in your state, and longer if your broker contract says so. MTM’s Pennsylvania agreement requires providers to keep full records of operations for 10 years or longer.

After the claim closes

A paid claim shows up on your loss runs at renewal for years, so learn from it. Review what failed, retrain the driver or change the procedure, and write down what changed. The incident investigation guide walks through root cause and corrective action, and a written fleet safety program is where the fix gets recorded so an underwriter can see it. The broader contract and insurance picture, including indemnity to brokers, is in NEMT liability.

Where the trip record comes from

One of the first things an adjuster asks for is the trip itself. HealthRide keeps it on every leg: scheduled and actual times, the driver and vehicle, addresses, signatures captured on screen, and GPS-verified miles, with the recorded route available to compare against the planned one. You can hand the adjuster that record the same day, exported from the trip log as a print-ready PDF or a spreadsheet. See reports for what the trip log includes.

When a rider is hurt: how passenger injury claims unfold for NEMT companies