Healthcare Insurance Archives

Why Do I Have To Pay Back My Health Insurance Company If I Win Or Settle My Personal Injury Case?

Personal injury cases take time to resolve, so health insurance is often needed to obtain immediate medical treatment for injuries caused by somebody else’s negligence. In such cases, California law allows health insurance companies to collect back what they’ve paid out from the responsible party (subrogation) and requires claimants to cooperate with these efforts. When you hire an experienced personal injury attorney, they’ll make sure that the subrogation on your case is handled so that you collect as much money as possible from your settlement or award. California Code 3040 and Health Insurance The money that’s owed to your health insurance company must be taken into consideration before settling your personal injury case. In most cases, your health insurance company is limited to collecting what they actually paid out for accident related care or one-third of the total settlement – whichever is the lesser amount (Common Fund Doctrine). It’s important to make sure that the money that’s owed to the health insurance company is accounted for in the breakdown of your settlement before you agree to sign a release. The Made Whole Doctrine The made whole doctrine can be helpful for cases where there is very limited insurance coverage for a loss. For example, lets say your health insurer paid out $50,000 for your medical care, but there is only $15,000 in coverage. In such cases the made whole doctrine may preclude the health insurance company from collecting back what they paid out, paying out $10,000 to you and $5,000 to your attorney. It’s important to know that some health insurance companies have language in their contracts that can override the made whole doctrine by giving the insurance company all rights of recovery to the extent of its payment.

Jun 18, 2019 | By Silva Injury Law, Inc. | Read Time: 2 minutes | Healthcare Insurance

Healthcare Subrogation! A Major Reason to Never Settle Your Personal Injury Case Without an Attorney…

You have settled your personal injury case on your own quickly after the accident. You are happy because you did it alone without an attorney and you think the settlement is all yours. Life is good, right? All of a sudden, you are getting letters and/or calls from your own healthcare insurance stating that they have a right to be reimbursed for the money your healthcare insurance paid out on your medical treatment for the injuries from the accident. Chances are they want more back than what you settled your case for in the end. What do you now? Whether you have private health insurance, such as Blue Cross, Kaiser, or Cigna or government health insurance, such as Medi-Cal, Medicare, or VA Benefits, the insurance company oftentimes has a right to subrogation if they paid any money towards your medical treatment for the accident. They essentially become a party of interest in your case since they are an injured party as well. They are an injured party because they only had to pay out money for your medical treatment because of the negligence of the third party who hurt you. Government health insurance plans, such as Medi-Cal, Medicare, or the VA have a statutory right to subrogation. In other words, there are laws on the books that preserve their right to subrogation. Private health insurance, such as Blue Cross, Kaiser, or Cigna oftentimes have contractual subrogation clauses in their policy agreement that you agreed to when you signed up for insurance with them. Failure to preserve their right to subrogation can cause someone who went at it alone in settling their personal injury claim trouble. If your health insurance is self-funded by your employer, your employer’s subrogation rights may fall under the umbrella of ERISA, which is another major issue for someone attempting to settle their case alone. ERISA is a big topic, meritorious of its own blog post. Stay tuned for that blog in the near future. Do not settle your case alone. Let a qualified personal injury attorney help you. A personal injury attorney can oftentimes get the amount the health insurance company is asking back dramatically reduced. Proceed with caution when it comes to settling your personal injury claim alone. Michael Joe Silva with Silva Injury Law, Inc. has great experience in settling healthcare subrogation liens and maximizing the total amount that ends up in his clients’ pocket. CALL SILVA INJURY LAW, INC. TODAY IF YOU HAVE BEEN INJURED AS A RESULT OF THE NEGLIGENCE OF ANOTHER!