Q My health insurer has paid my medical bills and now wants to be paid out of my settlement. Does my health insurer have a right to be paidback from the settlement?
AProbably. Most health insurance policies have a provision that allows the insurance company to be reimbursed for medical expenses that were caused by the negligence of a third party. This includes a negligent driver who injures you in a car crash. This right to reimbursement is known in legal terms as a "right of subrogation". The health insurance company bases its premium on the assumption that it will get reimbursed for payments made under these circumstances.
When our firm is involved, we make sure that the charges that the health insurer is attempting to recover were actually caused by the crash and not for something totally unrelated. We also attempt to negotiate a lesser amount for the payback so that you receive more of the settlement.
One of the real problems is when your health insurer has paid amounts that are more than the wrongdoer's insurance coverage. Often the health insurer will claim that it is entitled to all of that money instead of you. A law firm will need to investigate whether the health insurer is entitled to be paid first before you or whether you do. This determination is based on the policy language in the health insurance contract and case law. In many cases, we try to work out a compromise where you and the health insurer share the settlement funds based on some equitable distribution.