1, only if the traffic police determine that the party concerned is at fault and bear all medical expenses. At this time, the basic medical insurance fund will bear all medical expenses.
2. If the traffic police determines that the wrong party is someone else, the medical expenses of the party concerned will be borne by the third party. Medical insurance will not reimburse the medical expenses of car accidents, but medical insurance can reimburse part of the medical expenses.
3. Under special circumstances, if the victim is involved in a car accident, the traffic police judge that the other party needs to bear the liability for compensation. However, under the premise that the compensation obligor has not yet been determined, or the compensation obligor absconded, the traffic police department is pursuing it, but if the victim is in urgent need of treatment now, it can be actively advanced by the basic medical insurance. After the advance, the basic medical insurance fund has the right to recover from the compensation obligor.
To sum up, the premise of using medical insurance for reimbursement is that traffic accidents are unilateral accidents and injuries caused by improper driving, rather than accidents caused by a third person, otherwise they will not be reimbursed.
Legal basis:
People's Republic of China (PRC) social insurance law
Article 30
The following medical expenses are not included in the payment scope of the basic medical insurance fund:
(a) shall be paid by the industrial injury insurance fund;
(2) It shall be borne by a third party;
(three) shall be borne by public health;
(4) Go abroad for medical treatment.
Medical expenses that should be borne by a third party according to law. If the third party is unable to pay or cannot determine the third party, the basic medical insurance fund will pay in advance. After the basic medical insurance fund pays in advance, it has the right to recover from the third party.
Regulations on compulsory liability insurance for motor vehicle traffic accidents
Article 31
An insurance company can directly compensate the insured or the victim. However, if the insurance company needs to pay or advance the rescue expenses for rescuing the injured, the insurance company shall pay or advance the rescue expenses to the medical institution in time after receiving the notice from the traffic management department of the public security organ.
If the rescue fund management institution needs to pay the rescue expenses for rescuing the injured, after receiving the notice from the traffic management department of the public security organ, the rescue fund management institution shall pay the rescue expenses to the medical institution in time after verification.