Medical Expenses Arising from Traffic Accidents

The Highway Traffic Law No. 2918 regulates traffic and safety on Turkish highways. Article 98 of this law contains legal regulations regarding treatment expenses arising from accidents involving drivers or passengers. The article provides information on how the costs of healthcare services resulting from accidents will be paid.

This clause states that the medical expenses of drivers or passengers injured in an accident will be paid by the insurance company of the party responsible for the accident. This ensures that medical expenses are covered without the need for the injured party to file a claim. The same clause also outlines the necessary documents for payment of medical expenses for those injured in an accident and the conditions under which payments will be made. For example, medical reports from healthcare institutions are required to confirm the existence of injuries resulting from the accident.

The amendment to Article 98 of the Highway Traffic Law, now titled "Payment of Healthcare Costs," ensures that the healthcare costs of those injured in accidents are paid, eliminating the need for them to file payment requests

1. Medical expenses resulting from traffic accidents are covered by all healthcare institutions, regardless of whether they are private or public.
2. Regardless of whether the accident victim has social security coverage or not, the Social Security Institution (SGK) pays for healthcare services.
3. The article has been amended to use a more restrictive phrase, such as "health service fees," instead of the previous version which included the phrase "and other expenses required for treatment.".

Scope of Medical Expenses: Medical expenses may include all costs incurred to help a person injured in a traffic accident recover physically and prevent the worsening of their condition. These expenses may include services such as examinations and treatments by doctors and other healthcare professionals, medications, surgical procedures, physical therapy, rehabilitation, and other treatment programs. These expenses may vary depending on the extent of the damage caused by the accident and the length of treatment.

These expenses are generally paid by the Social Security Institution (SGK) if the injured party has social security coverage. If the injured party does not have social security coverage, the damage resulting from the accident is paid by the insurance company of the party responsible. Treatment expenses are not limited to hospital payments. They cover all expenses necessary for the person's recovery from the injury. For example, these include travel expenses, caregiver expenses, home care services, home treatment services, transportation costs, treatment access costs, treatment adaptation costs, and leave expenses. In addition, the costs of special equipment, adaptations, software, or software products necessary for the person to continue their work or school life after the injury are also included in treatment expenses.

Essentially, medical expenses are categorized under two main headings: healthcare expenses and recovery expenses. Healthcare expenses include services such as hospital, doctor and other healthcare professional examinations and treatments, medications, surgical procedures, physical therapy, rehabilitation, and other treatment programs. These expenses can vary depending on the degree of damage resulting from the accident and the length of treatment, and are generally paid by the Social Security Institution (SGK) or the insurance company of the party responsible for the accident.

Recovery costs include all expenses necessary for a person to recover from an injury sustained in an accident. These expenses include travel costs, caregiver costs, home care services, home treatment services, transportation costs, treatment access costs, treatment adherence costs, and leave costs. These expenses may vary depending on the severity of the injury and the length of recovery.

Who pays for the expenses of a traffic accident?

With the amendment published in the Official Gazette dated February 25, 2011, and numbered 27857, the liability for compulsory traffic insurance, which provides health coverage for traffic accidents in Türkiye, has been transferred from insurance companies and the Guarantee Fund to the Social Security Institution (SGK). The aim of this change is for the SGK to cover the necessary expenses for health services for individuals involved in traffic accidents. This ensures that accident victims do not face financial difficulties for healthcare and receive faster and more effective treatment.

The Social Security Institution is responsible for certain treatment expenses under Article 98 of Law No. 2918. However, treatment expenses not supported by documentation are not covered by Law No. 6111 and therefore are not reimbursed by the institution.

Law No. 6111 determines the degree of disability resulting from an accident and allocates benefits according to this degree. Factors such as the severity of the injury, the duration of treatment, and the loss of working capacity are primarily considered when determining the degree of disability.

Furthermore, documentation of the degree of disability resulting from the accident is required to cover these expenses. This means that injuries and disabilities must be documented, and reports determining the degree of disability are necessary. Therefore, treatment expenses not supported by documentation are excluded.

What medical expenses are covered by SGK (Social Security Institution)? Medical expenses, defined as documented expenses, are based on documents such as invoices or payment receipts that have a causal link to the traffic accident and are recorded in the SGK payment system. These documents demonstrate that the medical expenses were genuinely incurred as a result of the accident. Therefore, the existence of documented expenses is mandatory for medical expenses to be covered by SGK. Expenses not supported by documentation will not be covered.

Examples of expenses that can be covered, provided they are properly documented, include: expenses limited to medical treatment received at private or public hospitals, university hospitals, training and research hospitals, clinics, care centers, and physical therapy and rehabilitation centers; expenses for first aid and ambulance services; expenses for examinations; expenses for laboratory tests (blood tests, X-rays, ultrasounds, CT scans, MRIs, etc.); expenses for treatment (medication, blood, serums, surgery, intensive care, prosthetics, orthopedic surgical materials, dressings, dialysis, etc.); expenses for physical therapy and rehabilitation at healthcare facilities after treatment; and expenses for other medical supplies obtained with a doctor's report.

Undocumented Medical Expenses:

Undocumented medical expenses are generally defined as expenses that cannot be proven or documented as being related to the traffic accident. These expenses may include, for example, psychological treatment after the accident, alternative medicine methods such as massage and physical therapy, and social and economic damages incurred by the individual after the accident. These expenses are excluded from coverage and are generally stated to be the responsibility of the insurance company and the vehicle owner or driver. However, whether the driver or vehicle owner is liable and whether the expenses will be covered is investigated by the insurance company. Expenses incurred during treatment include:

• Hospital caregiver/advisor expenses,
• Travel expenses for treatment,
• Costs incurred during the recovery process,
• Travel expenses for treatment (taxi fares, intercity bus, train and plane fares for treatment and check-ups in other cities, etc.),
• Private home care expenses,
• Other medical expenses that cannot be billed for treatment purposes (such as medications not covered by SGK, wheelchairs, crutches, canes, air mattresses, etc., which do not require a doctor's report) are included. These expenses are covered by SGK, but they must be documented and supported by a doctor's report for reimbursement.
• Finally, it should be noted that when filing a lawsuit, the Social Security Institution (SGK) must be listed as the defendant in the lawsuit petition. If the SGK is not listed as a defendant, it cannot be included in the lawsuit. Furthermore, since their areas of responsibility differ, when filing a lawsuit for medical expenses, it should be clearly stated which medical expenses are requested (whether documented or undocumented) or all of them, and the responsible organization (the insurance company, the SGK, or both, depending on their responsibility) should be included as a defendant in the lawsuit petition. This clearly defines the subject of the lawsuit and establishes the defendant's liability. In fact, requesting documented and undocumented expenses separately in the lawsuit petition will minimize any document deficiencies or ambiguities that may arise later in the lawsuit process.