Is it true my health insurance can take some of my personal injury settlement?
Jan 19th, 2007 | By Michael L. Saile, Jr., Esq. | Category: Blogs, Pennsylvania Injury InformationYes it is true under certain circumstances. If you are injured in an automobile accident, your medical bills will first be paid from any medical coverage available to you under any automobile insurance policy from which you can draw coverage. Once those benefits are exhausted, your health insurance will cover insured expenses. If you do not have health or automobile insurance, or if you exhaust all of the limits of benefits of both, you may be eligible for medical assistance benefits.
Under some circumstances, insurance companies that pay out on claims are “subrogated” to any money the injured insured later wins in a lawsuit. If, for example, a workers’ compensation insurance company pays benefits to a worker injured by a defective workplace machine, that insurance company is entitled to reimbursement if the worker later sues the machine manufacturer and wins.
However, Pennsylvania law broadly forbids insurance companies from demanding subrogation rights to the money won by injured persons who bring lawsuits over motor vehicle accidents. So, if your automobile or health insurance company paid your medical bills from an automobile accident injury, you do not have to pay the company back if you win a personal injury award – unless you have insurance through a “health maintenance organization,” or “HMO.”
Recently, the Pennsylvania Supreme Court analyzed the precise language of the Pennsylvania HMO statute and decided that the statute bars subrogation only for insurance companies and other health-care programs but not for HMOs. If you have a claim against a negligent driver, and some or all of your medical bills were paid by an HMO, you must consult with the HMO before settling your claims. The HMO will be entitled to reasonable reimbursement. Examine your health insurance information. With most health insurance companies capping maximum lifetime benefits, and now that HMOs are allowed to seek reimbursement for medical bills, it is wise for Pennsylvania consumers to examine their choice of medical benefits coverage under their automobile insurance policies. All Pennsylvania automobile policies must provide a minimum of $5,000 in medical coverage. Especially if you have HMO health coverage, consider boosting your medical coverage under your automobile policy now. The cost is often very affordable, and it is wise to maximize the medical coverage available to you for automobile accidents.
There is also another way that your health insurance can take part of your settlement proceeds. If you have a self-funded health insurance plan from your employer, you may have to pay the insurance company back the amount that it paid for your medical bills. We will explain this type of health insurance payback in another blog entry.
Michael L. Saile, Jr., Esq. of Saile & Saile LLP, Attorneys-at-Law focuses his practice on fighting for plaintiffs’ personal injury victim’s rights in both Pennsylvania and New Jersey. We handle all serious injuries, car accidents (both limited and full tort), wrongful death, slip & fall downs, construction accidents, Septa, NJ Transit, and other cases other cases. We are located just outside of Philadelphia in lower Bucks County. Please visit our personal injury only website at www.pa-nj-injurylawyer.com for more injury information.
Once I exhausted my auto benefits, I notified my primary healthcare provider. They requested that I show proof that my PIP had been used up. I sent them all the information. As soon as the accident happened 6 years ago, I filed suit. I just recently settled the case only to find out that my insurance company put a lien on the settlement. At the time I notified my primary health Insurance provider, they did not provide any information to me about subrogation. I’m also certain that at the time I had a PPO policy through either Lumenos or United Healthcare. Are they required by law to notify me that they will be subrogating my claim? I live in PA.
This is a very complicated question. I believe the status of the current law would require your health insurance carrier to promptly notify you of a lien on your personal injury case as soon as the health insurance company discovers that there should be a lien on the case. Some types of liens on PA injury cases do not require notice. You should consult with your Pennsylvania personal injury lawyer to determine whether your lien is payable and also attempt to negotiate a discount on that lien.
2 3/4 years ago I was involved in a car accident. During the course of my physical therapy I switched health care providers. I have been left permanently disabled, requiring a cane to walk (I am only 30.) I have already received settlement money from both car insurance companies involved, receiving the money about 2 years ago. Can my health insurance companies still come after me for the money they paid for my care? I heard that they have 2 years, but is it 2 years after the accident? Date of medical care? Receipt of settlement? I recently received a EOB from my insurer stating that they need a copy of the exhaustion letter from my car insurance to process a claim. They processed the others, I don’t understand why it is an issue now. I am afraid if I send it to them they will realize that they should come after my settlement money.
I was in a same situation a few years back and did the same what you have done after reading your post i felt very bad to hear this .
I was in an A/A on 9/3 of this year.I had back xray and a MRI of my brain and LS spine.the MRI showed a bulging disc at L-5.I went to a neurosurgeon who was no help and I waited 7wks to see him.My pain,numbness and tingling in my legs and back has gotton worse everyday.I went and saw anorthopedic surgeon and am going to have inhections in my back and PT 2-3 times a week for 6 wks.If this dosent resolve my pain I will need surgert,which is dangerous because of where the herniation is.I plan on sueing the other driver’s ins. For a substanticial amt.of money.Due to my pain and sufferring,not just mine but the amt it caused my faimily.I’m also suing for lost wages for myself and my husband.The amt of money I lost from missing work is around 15,000 alone.My husband is still working on his amt.I have a lawyer but have not signed any paper work yet.there will also be about 4-7,000 dollars in medical cost.For the PT,sterid injections,doctor’s visits,the MRI’s and the Xrays and presciptions.My questions is Can my insurance (health ins.united heathcar)take that money?Thank you,Tracey Lane this will effect how mucj I sue for,because the lawyer gets 1/3.The other driver had no damage at all.
Your question is very complicated. It will take a lawyer to sit down and sift through everything, including your health insurance plan documents. Unfortunately, lawyers are not allowed to give specific legal advice on a blog. You must sign an agreement with a lawyer before specific legal advice can be given.
I was reare ended by someone who was speeding and text messaging. Both vehicles were totalled. I have had to have therapy, reconstructive surgery on my shoulder and surgery on both wrists. If I have exhausted all if her pip, what happens? Does this mean I will not be compensated for all of my lost wages, pain and suffering, and permanent injuries with upcoming surgeries? Blue cross blue shield has paid for all of the medical bills because I had met my out if pocket and deductible before the wreck. Now what happens?
Kizzi,
Please tell me what state the accident was in or email me privately.