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Understanding How Health Insurance Companies Can Affect Your Personal Injury Claim

There are several kinds of health insurance or programs that come into play when working through your personal injury case. As you read about each below, remember that you get the total face value of your medical bills as a component of your damages in your case. So even if you have to pay them back, you still get to pocket the difference from what they paid and the face value of the bill.

Health Insurance

If you are fortunate enough to have health insurance, it is most likely paying for your treatment. We can almost guarantee you will receive letters and forms from your health insurer asking about your personal injury claim and then demanding to be repaid once you settle. This is called “subrogation.” We don’t know how health insurance companies find out your treatment is related to a personal injury claim. We suspect hospitals and other providers are required to check a box on firm notifying insurance companies of whether your treatment is related to a third-party event, such as a car accident.

Health insurance subrogation is an extremely complex legal question and you absolutely need to involve us or another lawyer if you want to fight having to repay. The issue involves closely scrutinizing the language in your health insurance policy, which almost everyone has never seen or read. It also requires we read and analyze Federal and Georgia law to figure out which applies. Sometimes Georgia law applies and sometimes Federal law does.

If you end up having to repay your health insurance company, there are a couple of things to keep in mind. First, the medical expenses in your Demand were based on the full value of your medical bills. The insurance company only wants the money it paid, which is often less than the face amount of the bill. This means you get to keep the difference.

Secondly, everything in a personal injury claim is negotiable. We will call the health insurance claims representative and try to negotiate a reduced amount in exchange for a letter saying you paid a reduced amount as full and final payment.

Car Accident Medicare/aid Coverage

These are federal programs that have the strongest right of reimbursement possible. You will have to pay them back. Unlike health insurance companies, Medicare and Medicaid are not that good at finding out about your claim and contacting you to notify you about reimbursement. There is no legal time limit on when Medicare/Medicaid can come to you for repayment, so we need to be proactive in resolving this. When this situation arises, we will contact Medicare/Medicaid and request an itemization and payoff amount. Just like health insurance, we will try to negotiate down the amount you owe. Just keep in mind that we have to deal with federal bureaucracy, which will slow down the settlement process.