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Why Does My Health Insurance Company Want to Take Cash From My Personal Injury Settlement?

Posted by Jarome Gautreaux | Jun 16, 2015 | 0 Comments

This happens to a lot of folks who are able to reach a settlement of their injury cases, whether they are injured in an auto or tractor trailer wreck, slip and fall, workplace injury or injured by a defective product. The injured person is able to get a fair settlement from the insurance company for the party who injured them, but then the injured person's own health insurance company comes running with their hands out for a portion of the settlement. And every dollar they get is a dollar less to compensate you for your injuries. How can that happen?

Many health insurance companies put language in their contracts that allow them to be reimbursed when an insured person uses their health insurance to pay for treatment of injuries.  Here's an example.  Suppose Mary is injured in in an auto wreck, goes to the emergency room for treatment of her injuries, and is later seen by her doctor for follow-up treatment.  Her health insurance company pays $5,000 for all this treatment.  Mary later settles her injury claim against the other driver for $15,000.  But her health insurance company has told Mary that it is entitled to be repaid the $5,000 from Mary's settlement.   

And if Mary just ignores the health insurance company, she could get sued for violating the terms of her health insurance contract.  

There are now thousands of folks employed in the reimbursement/subrogation field to try to make sure they find out if your injury was caused by some sort of carelessness or negligence.  This has become its own industry, with millions at stake. Careful planning is necessary to make sure these claims are handled properly.  

I often tell my clients that my job is really two-fold in these types of cases:  get the settlement amount as high as possible, and get the reimbursement amount to the health insurer as low as possible.  Both of these put more money in an injured client's pocket to compensate them for their injuries.

So, a good personal injury lawyer in Georgia or elsewhere will help you decide what your rights are and whether you have to reimburse your health insurance company from your personal injury settlement.  Often, these reimbursement claims can be settled for a portion of what is claimed, but the details can get tricky.  This is one area where I usually recommend that clients need a lawyer to help guide them through the state and federal laws that apply to reimbursement claims.  

Here's an short article on reimbursement in Bloomberg that discusses this issue and gives a good overview.  

About the Author

Jarome Gautreaux

Jarome Gautreaux is a personal injury trial lawyer who represents people in Macon, and across the State of Georgia and other states, who have been seriously injured, as well as the families of people killed because of carelessness or negligence.  Jarome has successfully recovered for his clients over 100 million dollars in a variety of personal injury cases.  He is often asked by other lawyers to become involved in complex personal injury litigation.

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