The adversarial insurance company will only make one settlement payment, which will be in exchange for termination of the case.
This answer is often of great concern to many folks, especially those without health insurance and people who face damage to their credit ratings for unpaid medical bills. However, it is a rule without exception.
Over the years, I have successfully negotiated with health care providers to avoid collections until after a case is over and this is something I will attempt to do for my future clients. Please keep in mind that this is usually not possible, but I will try my best.