Subrogation refers to the right of a party to take on the legal rights of another party. For example, you assign your right to health insurance benefits to your doctor’s office. As a result, the doctor’s office can file health insurance claims and receive payments from your health insurance provider.
Another example would be a family assigning the rights to a life insurance policy to a funeral home for payment of service. The funeral home files the claim and receives the life insurance payment.
Health insurance carriers file subrogation claims in personal injury cases. They seek to recover money paid for medical bills related to a personal injury claim.
How Does the Subrogation Process Work in a Personal Injury Case?
The at-fault party is responsible for your damages after an accident or injury. That includes medical bills and other economic damages.
However, the auto insurance company for the at-fault driver does not reimburse you for medical bills until your case settles. The same is true for other personal injury cases.
Therefore, accident victims are responsible for paying medical costs as they incur the expenses. Many accident victims file a claim with their health insurance provider for medical bills for a car accident. Their health insurer pays the medical bills according to their health insurance coverage terms.
However, the insurance company notates each bill it pays related to the accident or injury. Therefore, your account is flagged as having a potential personal injury claim.
Your health insurance provider notifies you of its subrogation rights. It also states its intention to take steps to recover the money it paid related to the injury claim.
You may think the subrogation process is unfair. However, most health insurance policies contain language giving the company the right to pursue subrogation claims.
The company could pursue a subrogation claim against the at-fault party even if you decide not to file a personal injury claim. You would be required to cooperate with your health insurance company in recovering the money it paid. If you do not cooperate, you breach the contract, and you could lose your health insurance coverage.
Subrogation Claims Are Paid From Personal Injury Settlements
Subrogation prevents double recovery in personal injury cases. You cannot recover money for medical bills your health insurance company paid. Otherwise, you would profit from your injuries at the health insurance provider’s expense.
Your personal injury lawyer verifies all outstanding medical bills and medical liens. They also verify subrogation claims. These amounts must be paid before receiving any money for your injury claim.
An insurance company is not required to waive subrogation rights or accept a lower payment for its claim. It is true even if your settlement proceeds do not compensate you for your losses after paying medical liens and subrogation claims.
Your lawyer can negotiate with your health insurance provider to accept a lower amount to satisfy its insurance subrogation claim. Our skilled Fort Worth personal injury lawyers diligently negotiate medical liens, medical bills, and subrogation claims to keep as much money in your pocket as possible.
Do Government Health Insurance or Assistance Programs Have Subrogation Rights?
A government health insurance provider or agency has the same subrogation rights as a private health insurance provider. Therefore, Medicare and Medicaid can file subrogation claims for amounts paid related to a personal injury claim. Their claims must be paid from your settlement proceeds.
Failing to reimburse Medicare or Medicaid for a subrogation claim could create problems with future coverage. Your attorney negotiates lower payments for these claims whenever possible.
What is a Waiver of Subrogation in a Personal Injury Settlement Agreement?
Insurance companies always look out for their best interests. You should always have an accident lawyer review a settlement agreement before you sign it.
The insurance company for the at-fault party might include a subrogation waiver in the settlement agreement.
However, the wavier does not protect you. Instead, it protects the company from liability for additional claims. Signing a settlement agreement with a subrogation waiver could cause problems for you with your health insurance coverage.
An insurance company may also try to calculate damages by using the reduced rate for medical services billed to a health insurance provider. The company does this to decrease the amount it pays you for your injury claim.
The reduced rate is only available because of an agreement between the health insurance company and the medical provider. So if you miss this common insurance tactic, you could be responsible for the difference.
Schedule a Free Consultation With a Fort Worth Personal Injury Lawyer
Subrogation claims can be confusing. Our legal team tracks claims and attempts to negotiate payments for these claims.
If you sustained injuries in an accident, contact our law office for a free consultation with a personal injury attorney in Fort Worth. Let’s discuss how we can help you recover the compensation you deserve after an injury or accident.