Law Office of Michael D. Waks

A Lawyer You Can Trust

No Fee Unless You Win

Call888.394.1174

Available 24/7

  • Home
  • Attorney Profile
  • Reviews
  • Practice Areas
    • Personal Injury Lawyer Long Beach
    • Personal Injury Lawyer Cardiff
    • Motor Vehicle
      • Auto & Car Accidents
      • Bus Accidents
      • Distracted Driving
      • DUI Victim
      • Motorcycle Accidents
      • Truck Accidents
      • Wrongful Death
    • Premises Liability
      • Construction Accidents
      • Premises Liability
      • Electrical Accidents
      • Private Property Accidents
      • Slip and Fall Accident
      • Swimming Pool Accidents
    • Other Practice Areas
      • Brain Injury
      • Burn Injury
      • Bicycle Accidents
      • Boating Accidents
      • Dog Bite Accidents
      • Legal Malpractice
      • Pedestrian Accidents
      • Product Liability
      • Sexual Assault
      • Spinal Injury
  • Case Results
  • Videos
  • Resources
    • California Law Enforcement Information
    • California Personal Injury Laws and Statutory Rules
    • Other Resources
    • Personal Injury Law FAQs
    • Personal Injury Resources
    • Physical & Emotional Recovery Support
    • Southern California Courts
  • Blog
  • Contact Us

Is Health Insurer Entitled to Portion of My Personal Injury Payout?

May 18, 2021 by Michael Waks

Is My Health Insurer Entitled to Some Portion of My Personal Injury Payout?

The costs associated with treating unanticipated injuries can add up fast. Medical bills alone can amount to tens—if not hundreds—of thousands of dollars. While your health insurer may cover the majority of your medical bills, they might request reimbursement if you end up securing a payout from those liable for your injuries. This probably seems unfair, especially if you worked incredibly hard to recover what was rightfully yours; however, as long as the terms of your policy have a subrogation agreement, it’s perfectly legal.

Subrogation clauses grant insurers the right to pursue funds from those liable for the claims they pay out. For accident victims who file successful personal injury claims, that means claiming a portion of the resulting settlement or verdict. In other words, even though your health insurance carrier is responsible for covering your medical bills up to the policy’s limits, you may be responsible for reimbursing them if your end up securing a payout that includes compensation for such expenditures.

Unfortunately, most policies—including both those provided by private carriers and by the government—contain a subrogation clause. Therefore, as long as your insurer upholds their end of the contract by paying at least a portion of your medical bills, they likely have a right to be paid back, or indemnified, from any associated recoveries you receive.

If your case proves unsuccessful, however, your insurer cannot invoke their right to reimbursement. This is because healthcare insurance carriers are only entitled to funds from personal injury payouts; claimants do not have to compensate providers out of pocket for expenses the latter was obligated to cover under the terms of the policy.

How Can I Keep as Much of My Personal Injury Payout as Possible?

If your personal injury claim ends up yielding a sizable payout, it’s natural to worry about just how much your insurer is going to try to take. Fortunately, just because your policy has a subrogation clause doesn’t mean you’re automatically obligated to reimburse your carrier for 100 percent of your medical bills.

Generally speaking, policyholders have some negotiating power. Since claims adjusters are essentially professional negotiators, though, it’s unadvisable to go up against them on your own. Instead, consult a strategic personal injury attorney, who will not let the opposing party manipulate you into surrendering any more than is fair.

After reviewing the terms of your policy and the treatments you’ve been receiving, your lawyer will remind the insurer of their obligations to you. As long as you’re up-to-date on your premiums, they are responsible for covering at least some portion of your medical bills—without the expectation that you will reimburse them. As such, they don’t have an automatic right to the entire payouts you recover.

A seasoned personal injury attorney will be well-versed in all kinds of negotiation tactics and legal strategies, which he or she can apply as needed to help you retain as much of your recovery as possible. For example, your lawyer may start by reminding the insurer of the made-whole doctrine.

This defense essentially states that you must be “made whole” before reimbursement can occur. That means your insurer must prove that your life has been restored to the way it was prior to your injuries before they can assume a portion of your settlement or judgement.

Naturally, this will pose a challenge if you sustained catastrophic injuries. Some injuries are so severe that you can’t ever restore the way your life was prior to their occurrence.

Determining the actual amount that your carrier paid for your medical care is another viable negotiation tactic. Your legal team will evaluate your medical records line by line to determine precisely how much your healthcare providers billed for their services versus how much your insurer actually paid. Chances are the figures won’t be the same.

The emergency department might have billed you $2,000 for x-rays, for example, and $500 for medication, but your carrier might have only paid $1,200 for the former and $250 for the latter. While your insurer might try to recover $2,500 from your payout by presenting the hospital’s bills, you don’t owe them a penny more than $1,450. An attorney will let them know as much—and an exceptional attorney will negotiate for an even lower figure.

When Should I Hire a Personal Injury Attorney?

If you were seriously hurt through no fault of your own, it’s generally advisable to call an attorney as soon as possible. An attentive lawyer will prevent you from making critical mistakes early on that jeopardize your case down the road.

For example, if you fail to record your non-economic damages like emotional distress and loss of enjoyment in life diligently, you may have a hard time applying the made-whole doctrine. If you only supply evidence of economic damages and the payout you secure covers all of them and then some, your insurer will have adequate grounds for a claim of their own.

If you didn’t hire an attorney for help with your case from day one, it’s wise to seek legal counsel as soon as you learn that your health insurance carrier wants to take a portion of your settlement or judgement. The sooner you enlist help from a seasoned professional, the sooner you can start devising a strategy for negotiating with the insurer so you don’t have to surrender a significant share of your payout.

Call (562) 206-1939 to Discuss Your Case with a Long Beach Personal Injury Attorney

Your Injuries Are Personal to Me

If you were seriously hurt through no fault of your own, contact the Law Office of Michael D. Waks. We take great pride in helping the injured recover the compensation they need to move on with life.

A top-rated trial attorney, Michael D. Waks has been representing the injured and their loved ones for more than 30 years. Call (562) 206-1939 or fill out our Contact Form to schedule a free consultation with a personal injury lawyer in Long Beach.

  • Author
  • Recent Posts
Michael Waks
Michael Waks
Michael Waks is an aggressive advocate for people who have suffered because of someone else’s actions. Michael decided to become a personal injury lawyer when, while clerking at a legal defense firm during law school, he witnessed and was infuriated by asbestos manufacturers spending millions to avoid taking responsibility for the egregious injuries they caused. Immediately after passing the bar, Michael opened his own firm in Long Beach, CA to help the victims of personal injury accidents get every benefit owed them under the law.
Michael Waks
Latest posts by Michael Waks (see all)
  • How to Help Your Loved One Cope with a Spinal Cord Injury - October 27, 2021
  • How Can I Prove a Motorist Fell Asleep in Traffic? - October 20, 2021
  • Filing a Truck Accident Claim? Avoid These Common Mistakes - October 13, 2021
Share here...
Avatar for Michael Waks

About Michael Waks

Michael Waks is an aggressive advocate for people who have suffered because of someone else’s actions. Michael decided to become a personal injury lawyer when, while clerking at a legal defense firm during law school, he witnessed and was infuriated by asbestos manufacturers spending millions to avoid taking responsibility for the egregious injuries they caused. Immediately after passing the bar, Michael opened his own firm in Long Beach, CA to help the victims of personal injury accidents get every benefit owed them under the law.

Law Office of Michael D. Waks

Get a Free Consultation

  • Submission of this form does not create an attorney-client relationship.
  • This field is for validation purposes and should be left unchanged.

Testimonials

Michael represented me in a personal injury case and I can’t recommend him enough. From the very first consultation he made sure that I was always aware of my options and up to speed with every aspect of my case. He answered all my questions and used his experience and expertise to help guide my decisions instead of trying to make them all for me. He not only ensured that the settlement I received was more than enough to cover all my bills and expenses but he also made sure I had piece of mind and would be taken care of going forward.

– Eric G.‎
Read More Testimonials

Categories

  • Bicycle Accidents
  • Boating Accidents
  • Brain Injuries
  • Burn Accidents
  • Bus Accidents
  • Car Accidents
  • Construction Site Accidents
  • Disability
  • Distracted Driving Accident
  • Dog Bites
  • DUI Victim
  • Electrical Accidents
  • Government Entity Claims
  • Legal Malpractice
  • Motorcycle Accidents
  • Pedestrian Accidents
  • Personal Injury
  • Premises Liability
  • Private Property Accidents
  • Product Liability
  • Sexual Assault
  • Slip and Fall
  • Spinal Cord Injuries
  • Train Accidents
  • Truck Accidents
  • Uncategorized
  • Uninsured Motorists
  • Wrongful Death
– BACK TO TOP –

Visit Us

Long Beach Office
1 World Trade Center, Suite 800
Long Beach, California 90831
P: 562-206-1939
F: 562-676-4388
Get Directions

Cardiff Office
160 Chesterfield Dr., Suite 200
Cardiff, CA 92007
760-767-8031
Get Directions

Call Us

888-394-1174
SCHEDULE A FREE CONSULTATION
Personal injury lawyer Long Beach
Car accident lawyer Long Beach
Google Review
  • review_star
  • review_star
  • review_star
  • review_star
  • review_star

Michael Waks is The attorney you want to resolve your accident issues, period. He is knowledgeable, efficient, and gets maximum results when you are injured.

— Joe M
  • facebook-app-symbol
  • twitter
  • linkedin
  • pinterest
  • youtube
  • Disclaimer
  • Privacy Policy
  • Scholarship
  • Sitemap

This website is for informational purposes only and should not be construed as providing formal legal advice.

Copyright © 2022 by Law Office of Michael D. Waks

Website & SEO By Sutton Digital Marketing