Understanding Your Rights

What If Your Health Insurance Provider Wants Part Of Your Settlement?

If you have health insurance and are involved in an accident, there is a possibility that your insurance provider could make a claim on any settlement you receive. Whether or not you can stop the provider from taking part of your money depends on various factors. To help you understand what could happen and your options, here is what you need to know. 

What Happens After an Accident?

After you are involved in an accident and receive medical treatment, you will most likely receive a letter from your insurance provider. The letter is known as the subrogation notice. The purpose is to obtain information from you regarding the accident. 

The provider wants to know several things, including whether or not you were responsible for the accident and if you have obtained legal counsel. 

The provider also uses the letter to stake a claim on your settlement. If you receive any payment for medical expenses that the provider has already paid, you will be asked to reimburse those funds. 

Whether or not the provider is actually entitled to those funds depends on the language in your insurance policy.  

Does the Provider Have a Claim?

To determine if your insurance provider really does have the right to claim part of your settlement, you need to read your policy carefully. In the policy, look for any language that could be considered as an agreement to reimburse the provider. The word "subrogation" might even be used. 

If the provider has not included this language in the policy, you might be able to argue that it is not entitled to reimbursement. In this instance, your attorney could send notice of your intention to dispute the claim and why. 

What If the Policy Gives the Provider Claim Rights?

There is a possibility that your state's laws prevent the insurance provider from seeking reimbursement. Review your state's laws with your attorney. Even if the law allows reimbursement, there might be restrictions that can reduce the amount that the provider receives. 

Even if your state's laws do not reduce or eliminate the claim, you have some options available to try to lower the amount owed. For example, you can demand a reduction in the amount of the claim to account for your attorney's fees. If your attorney is charging 25 percent of your settlement, ask for a 25 percent reduction in the claim. 

You can also ask for an itemized listing of all the injuries that the insurance provider is claiming reimbursement for. It is possible that some of the bills paid was not related to the accident in which you were involved, which means that the claim does not apply to them. 

Work with an experienced attorney like Walsh Fewkes Sterba to find other ways to lower the claim from your insurance provider.