Abstract This paper explores some of the basic similarities and differences between fault-based and no-fault systems of automobile accident insurance from the perspective of a U.S. state and the laws of Macedonia. The majorities of U.S. states have adopted an at-fault system of compensation and therefore share more similarities with Macedonia than the laws of a dozen U.S. states that have adopted a no-fault system. Whereas Macedonia employs a system of nearly universal health care, such is not the case in the United States. The respective states have adopted either a fault-based system or a no-fault system, but in either case issues of coverage for automobile accidents is more complicated for the lack of a nationalized health care system that at minimum acts as a safety net for treatment of injuries related to automobile accidents. It is posited that complications relating to the lack of universal health care coverage in the United States has led to significantly heightened regulatory intervention by the several states such that the similarities between the free-market approach of the states and of civil law (code) systems are greater than the differences. The paper is not based on empirical data of the legal systems or the medical systems, nor is the undeniable interrelation between a medical system and the corresponding legal system with regard to insurance coverage of primarily health-based issues considered other than to highlight how both may play a part in regulation of the automobile accident insurance industry in light the involvement of public health, safety and welfare.