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.
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