Special Situations

Medicare Denied Claim: Car Accident or Work Injury

Name: Medicare Denied Claim: Car Accident or Work Injury
Creator: Barley Billing Team
Published: 2026-03-26

Written by Barley Billing Team, Medicare Billing Experts | Last reviewed March 26, 2026

Does your notice say something like this?

"This service is the responsibility of another insurer"

"Medicare payment cannot be made because another payer must pay first"

"Benefits for this service are the responsibility of a third party"

If so, you're in the right place. Here's what it means and what to do.

What This Means

Medicare denied your claim because it believes another insurer should pay first. Under a federal law called the Medicare Secondary Payer (MSP) Act, Medicare does not pay for medical care when another type of insurance is responsible.

This usually happens when your care is related to:

A car accident — your auto insurance (or the other driver’s insurance) is expected to pay first
A work injury — workers’ compensation is expected to pay first
Another person’s negligence — liability insurance may be responsible

Medicare is the “payer of last resort” in these situations.

Why This Happens

You were in a car accident. No-fault auto insurance or the at-fault driver’s liability insurance is required to pay before Medicare. This applies even if the accident happened years ago, as long as treatment is still related to the accident.
You were injured on the job. Workers’ compensation covers job-related injuries and illnesses. Medicare will not pay for care that workers’ comp should cover.
Medicare’s records show other insurance is involved. Medicare’s Benefits Coordination & Recovery Center (BCRC) tracks information about other insurance. If they know about your accident or injury, claims may be denied automatically.
Your provider did not bill the correct insurer first. The claim may have been sent to Medicare before the primary insurer had a chance to process it.

Should You Appeal?

Appeal outlook: Mixed

Whether to appeal depends on your specific situation:

If the injury really is covered by auto insurance or workers’ comp, an appeal of the Medicare denial will not succeed. The other insurer needs to pay first.
If workers’ comp or auto insurance denied your claim, you may be able to get Medicare to pay by providing proof of that denial.
If your treatment is not related to the accident or work injury, you can ask Medicare to review the claim with documentation from your doctor explaining why.

The key question is whether another insurer is truly responsible for the care in question.

What To Do Next

Figure out which insurer should pay first. If your care is related to a car accident, contact your auto insurer. If it is related to a work injury, contact your employer’s workers’ compensation carrier.
File a claim with the responsible insurer. Your provider’s billing office may need to submit the claim to the correct insurer first before Medicare will consider it.
If the other insurer denied your claim, gather the denial letter and send it to your provider’s billing office. They can resubmit to Medicare with proof that the other insurer will not pay.
Ask about conditional payments. If the other insurer is slow to pay, Medicare may make a conditional payment to cover your bills in the meantime. Call the BCRC at 1-855-798-2627 to ask about this option.
If you are not sure what to do, call 1-800-MEDICARE (1-800-633-4227) or contact your State Health Insurance Assistance Program (SHIP) for free help.

Sources

CMS: Medicare Secondary Payer Overview — explains when Medicare pays second
CMS: MSP Manual, Chapter 3 — Liability, No-Fault, and Workers’ Compensation — detailed rules for accident and injury claims
Medicare.gov: Who Pays First — general coordination of benefits rules
CMS: Conditional Payment Information — how conditional payments work

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Appeal Deadlines — Check Your Notice for Exact Dates

Original Medicare

120 days from the date on your MSN

Medicare Advantage

At least 60 days (check your denial notice for exact deadline)

Not sure which you have? Check the top of your denial notice. If it names a private insurance company (like Humana, UnitedHealthcare, or Aetna), you have Medicare Advantage. If it says "Centers for Medicare & Medicaid Services," you have Original Medicare.

Frequently Asked Questions

Can Medicare ever pay for injuries from a car accident?

Yes. Medicare can make what is called a 'conditional payment' to cover your medical bills while you wait for the other insurer to pay. However, Medicare will then seek repayment from the settlement or insurance payment you receive later.

What if workers' comp denies my claim?

If workers' compensation denies your claim, Medicare may then cover the services. You or your provider should submit the workers' comp denial to Medicare along with a new claim so Medicare can process it.

What happens if I settle my car accident case?

If you receive a settlement from an auto or liability insurer, Medicare has the right to recover any conditional payments it made for accident-related care. This is called Medicare's recovery right, and it applies even if you settle for less than the full cost of your care.

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This information is for educational purposes only and is not legal or medical advice. Always verify with your doctor's office and insurance company.