YOUR HEALTH INSURANCE COMPANY WILL TRY TO TAKE YOUR PERSONAL INJURY RECOVERY AWAY FROM YOU
14 05 08 - 10:34
Years ago when a personal injury attorney obtained an adequate recovery for a personal injury claimant, their job was done.
Now however, once an adequate recovery is obtained from the careless driver's insurance company, the job is only half way done.
The next battle for the personal injury lawyer is a fight with their client's health and hospital insurance company which will make a claim for reimbursement of all medical hospital bills paid under the injured party's health insurance policy.
In most cases, these claims by health insurance carriers can be successfully defeated such that the injured party does not have to pay any money back to the health insurance carriers.
Under North Carolina law it is illegal for a health insurance company to put a provision in a health insurance policy that requires the insured to reimburse the health insurance company for medical bills they paid under their health insurance policies. These provisions are called "subrogation clauses".
Most health insurance policies are issued through the insured's employer. Sometimes these are not actually insurance policies but part of an employee benefit plan. However, for all practical purposes these employee benefit plans act as a regular health insurance policy. These employees benefit plans claim that they are governed under a federal law commonly known an E.I.R.S.A.
Federal law does allow subrogation clauses which allow the employee benefit plan to be reimbursed for health insurance benefits they paid to the insured if there is a recovery from the careless driver's insurance company.
Federal law does trump state law such that federal law applies and subrogation clauses are therefore valid if they are governed by E.I.R.S.A. law.
However, a good personal injury lawyer will know how to defeat the subrogation clauses in most cases such that the injured party can collect the full proceeds from the claim against the negligent driver without having to repay their health insurance company.
There are some health insurance subrogation polices which cannot be defeated. Among these are health insurance policies which insure federal employees or families of servicemen. These policies, are governed by a different set of federal laws which give these insurance companies real teeth to enforce their subrogation clauses. Even in these cases, however, a good personal injury lawyer may, under the right set of circumstances, be able to negotiate a lesser subrogation payment to these insurance companies.
The above discussion does not apply to Medicare and Medicaid benefits which are paid under still a different set of federal laws.
An experienced personal injury lawyer should be consulted when the health insurance company is attempting to take away part of an injury victim's motor vehicle claim proceeds.