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  • Writer's pictureRobert Schuerger II

Important Facts About Health Care Provider Claims on Personal Injury Settlements

In the aftermath of an accident that resulted in severe injuries, mounting medical bills can be very stressful for victims. It is not always easy to recover damages for the at-fault party, and in the meantime, medical expenses related to the accident will continue to pile up.

While waiting for their personal injury claim to be settled, victims usually turn to their health insurance provider to assist with the cost of medical treatment. Most health insurance companies will pay for their client's medical treatment up to the limits of their coverage.

However, when the personal injury settlement money comes through, the health insurer will expect its money back. Dealing with a government agency or private health insurance companies while trying to recover from serious injuries can be very difficult, especially when in the middle of a tough personal injury lawsuit.

This is why victims need to have an experienced personal injury lawyer by their side, to offer guidance when it comes to handling their personal injury claim and dealing with the health insurance company.

When in such a situation, victims in Nashville, TN can call and request a free consultation with a top-tier personal injury attorney from Schuerger Shunnarah Trial Attorneys. They will advise on medical records in a personal injury lawsuit as well.

Link Between Health Insurance and a Personal Injury Claim

Link Between Health Insurance and a Personal Injury Claim

In Tennessee, victims of injuries caused by another party's negligence are entitled to receive fair compensation through a personal injury settlement. Examples of such cases include car accidents, truck collisions, slips and falls, animal attacks, and much more.

By filing a personal injury claim, victims can receive damages covering the following losses:

  • Medical bills related to the injury

  • Property damage or destruction

  • Future medical expenses

  • Emotional distress

  • Lost wages

  • Pain and suffering

  • Potential loss of future income

The first step after getting injured in an accident is to seek medical treatment, which the doctors of the hospital will provide. After the patient is treated, the hospital or healthcare provider will seek payment from the patient's health insurance company.

In most cases, the health insurer will cover the cost of the medical bills and then investigate the cause of the injuries. Upon finding out that the patient filed a personal injury claim and recovered damages, health insurers will seek reimbursement from the settlement money.

Subrogation Claims and Liens Against a Personal Injury Settlement

To recover its money from the patient's settlement, a health insurance company may file a lien on the personal injury claim. If the patient has a pending personal injury case, this lien is called subrogation and will be settled once the lawsuit is completed.

Regarding personal injury claims, subrogate is to substitute one person or entity for another. This means the health insurance company simply wants to make sure that in the end, the responsible party pays for the medical expenses related to the accident, which means their health insurer pays, not the victim's.

What Are Reimbursement and Subrogation Claims?

While the terms reimbursement and subrogation are sometimes used interchangeably, they mean different things. When dealing with a personal injury case in which the victim's health insurance company paid their medical bills, and now wants to put a lien on the personal injury settlement, it is important to understand the difference between these two terms.

A subrogation lien is when the victim's health insurance company decides to pursue the negligent party responsible for the injuries so that it can recover the medical bills paid to the hospital. However, in most cases, health insurance companies will wait for the outcome of the personal injury claim and then recover its money from the settlement.

Regarding reimbursement claims, the health insurance provider will have no choice but to seek reimbursement from the victim directly. In other words, the health insurance company will have no right to go after the at-fault party on its own. The only option will be to wait for the victim to receive compensation from the lawsuit, then seek repayment from them.

Subrogation Notice Letters

As part of the investigations into the accident that caused the injuries, insurance companies can send a subrogation notice letter to the victim asking for further clarification about the incident. The subrogation notice letter can ask for the following information:

  • The nature of the accident

  • How serious the injuries are

  • The names of the medical providers

  • If a third party was involved

  • Whether the accident was work-related

  • The name and contact information of the at-fault party's insurance company

If any catastrophic injury lawyers in Nashville have been hired to handle the lawsuit, the insurance company will also require their names and contact information. However, the main purpose of the subrogation letter will be to remind the victim of the insurance company's right to seek repayment from the victim's settlement for the costs of medical care that the insurer paid for.

How to Handle a Subrogation Lien

A subrogation lien can make a personal injury claim a lot more complicated than it already is. This is because the victim will now have to consider the amount that will go to the insurance company when deciding how much compensation to ask for.

However, with the help of a competent personal injury attorney, victims can take steps to make the subrogation lien a lot easier to manage, such as:

  • Reviewing their health insurance policy

  • Verifying federal law and the health insurance laws in Tennessee

  • Requesting the removal of unrelated medical expenses

  • Negotiating with the insurance company

  • Making sure the insurance company pays for the attorney's fees

What Is A Medical Lien?

A medical lien is another important term to remember when dealing with personal injury claims. It is a security interest that is usually held by the medical provider, such as the doctor or hospital where the patient received treatment. A medical lien is a form of guarantee that the patient will be responsible for paying the costs of the treatment they received.

In cases where the victim does not have a health insurance policy or is unable to pay for medical care, a medical lien is often used by the health care providers. The lien may be placed on the victim's bank account or wages and usually remains in place until it is paid for in full.

There are many types of liens that health care providers can use, such as:

Medical Liens in a Personal Injury Case

In situations where the personal injury claim is dragging on for many months, or even years, the medical provider may continue treating the victim and put a lien on the settlement money that is expected at the end of the lawsuit. It means once the personal injury case is settled, the health care providers will get paid first, before the victim.

Health Insurance Company Liens

The health care providers may require reimbursement from the health insurer for the treatment they rendered to the patient after the accident. This is called a healthcare lien and is common in cases where treatment has already been given to patients who cannot afford to pay for it themselves.

Liens From Healthcare Providers (Hospital Liens)

When a patient has no means of paying the hospital bills but needs medical treatment, the medical provider may defer the payment to a later date. Such liens from healthcare providers are common in the following cases:

Personal Injury Claims

In this case, the victim was injured due to another party's negligence, and the healthcare provider will receive reimbursement as soon as the personal injury claim recovers a settlement. Schuerger Shunnarah Trial Attorneys has more information on understanding health insurance claims on personal injury settlements.

Uninsured Patients

When patients are unable to pay for the treatment they received, and they have no health insurance policy, the hospital may place a lien on the patient's assets or properties until payment is received.

Workers Compensation Liens

With work-related injuries, the workers' compensation insurance company will typically pay for all the medical bills that the victim has. However, if the result of the personal injury settlement reveals that a third party was responsible for the accident, the worker's comp insurance company has the right to get their money back and will place a lien on the settlement offer.

Medicare or Medicaid Liens

In situations where government agencies, such as Medicare or Medicaid are responsible for paying the patient's medical bills, they also have the right to seek reimbursement once the personal injury settlement comes in.

Negotiating a Lien

If the terms of a lien seem unfair, or too harsh, a personal injury lawyer can help the victim to negotiate with the lien holder for a better offer.

An example is when a lawyer can convince medical providers to lower rates for treating the patient in exchange for guaranteed payment when the personal injury case is completed. This will mean the hospital bill will be paid regardless of whether the case is won or lost. However, when dealing with government agencies, the victim cannot negotiate any reductions.

Experienced Lawyers Can Assist With a Personal Injury Lawsuit

Experienced Lawyers Can Assist With a Personal Injury Lawsuit

With so many factors to consider, dealing with health care provider claims on personal injury settlements becomes a mammoth task for injured victims. The best way to seek compensation in such cases is to approach a good lawyer. Victims who want to exercise their legal right to pursue compensation can call Schuerger Shunnarah Trial Attorneys and discuss the merits of their case during a free consultation.


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