After a car accident or slip and fall, an accident victim may use his or her medical insurance to pay accident related medical bills. There is nothing wrong with this. However, most health insurance policies contain contractual clauses requiring the insured (i.e., the person covered by the policy) to alert the health insurance carrier when there is an accident where a personal injury claim is made. In most cases, the injured victim’s accident attorney alerts the health insurance company in writing.
Health insurance carriers (e.g., Blue Cross Blue Shield, Cigna, United Healthcare, Humana) typically have a right of subrogation, which means that they are entitled to recover the amounts paid for accident related medical treatment. After an accident victim recovers a settlement or judgment, he or she must reimburse his or her health insurance carrier what it paid for accident related medical treatment (e.g., ER bills, ambulance bills, surgery, physical therapy, MRI imaging). The good news is that this subrogation amount is typically much less than the medical bills themselves because health insurance companies pay a lot less to medical providers (like emergency rooms) than these providers’ bills state.
An experienced personal injury attorney will save victims even more money because most private health insurance carriers discount (reduce) the subrogation amount owed in accident cases. Often, the attorney only has to ask for the discount.
Private health insurance companies do not have a statutory right to receive subrogation. Their right is of a contractual nature, and failure to honor an insurance company’s subrogation right may result in a cancellation of the injured victim’s health insurance. On the other hand, government issued health insurance (e.g., Medicare, Medicaid, Tricare) has a legal right (i.e., lien) to be reimbursed for accident related medical benefits paid; this right exists by operation of law, and the penalties for failing to repay these liens is even greater.
If you have a question about subrogation, health insurance or payment of medical bills after an accident, contact the Law Office of Donald D’Aunoy Jr., LLC today for a free case consultation.