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  • Writer's pictureRobert Schuerger II

Understanding Health Insurance Claims on Personal Injury Settlements | Maximizing Compensation with

Some injured victims may get medical treatment from health care providers covered by their health insurance company. When they receive personal injury settlements following their injuries, they may have the legal obligation to pay off the "lien" or subrogation claims.

Schuerger Shunnarah Trial Attorneys have extensive experience handling personal injury claims and health insurance liens. They can assess the subrogation or reimbursement claims and guide the injured victims in Nashville, Tennessee, on their legal options.

Understanding Health Insurance Claims on Personal Injury Settlements

Understanding Health Insurance Claims on Personal Injury Settlements

Under personal injury law, injured victims have the right to pursue compensation if they suffer injuries due to another's negligence.

However, seeking compensatory damages can take time, and to cover their medical care, the affected party may seek coverage under their health insurance policy.

After treatment, the injured victim may pursue a personal injury claim against the at-fault party's insurance company to recover the damages incurred. If they win the claim or lawsuit, they may receive compensation.

The health insurance company may conduct its own investigation into the accident. If it finds that the victim's injuries occurred due to another's negligence, it may want its money back for paying the medical bills by pursuing subrogation or reimbursement claims.

The Difference Between Subrogation Claims and Reimbursement Claims

After finding out about the personal injury settlement, the victim's health insurance company might pursue a subrogation lien claim or a reimbursement claim to cover the medical expenses they paid for. Although these two terms might sound similar, they're completely different.

Subrogation Claims

When a policyholder's health insurance company pays for medical expenses for the injuries caused by another's negligence, they have the right to pursue compensation. It can file a subrogation claim against the at-fault party's insurer to recover the costs it covered.

However, most health insurance companies do not want to go through the hassle of filing claims. They are more likely to wait for their policyholders to recover the compensatory damages so that they can pursue repayments from them.

Reimbursement Claims

If a health insurance company pays for its policyholder's medical expenses to treat their injuries caused by another's negligence, it has the legal right to recover the damages from the injured party by pursuing a reimbursement claim.

The key difference between subrogation and reimbursement claims is that in the latter, the policyholder's health insurer does not have the right to pursue recovery from the at-fault party's insurance company. It has to wait for its policyholder to receive a personal injury settlement before approaching them for repayment.

What Is a Subrogation Notice Letter?

After an accident, the health insurance provider might send subrogation notice letters to its policyholders or all of the parties involved in the personal injury case to inquire about the details of the incident.

The letter may ask for details about the accident, including the following:

  • The cause of the accident;

  • Name and contact details of the at-fault party's insurance company; and

  • The name and contact details of the victim's personal injury attorney (if they've hired legal representation).

Besides inquiring about the facts surrounding the case in the subrogation notice letter, the health insurer will also explain their right to recovery in case of any personal injury settlements or verdicts.

The main purpose of subrogation claims is to protect the rights of private health insurance companies. If they're covering the medical bills arising from another's actions, it's their right to seek reimbursement and cover their incurred costs.

What Should an Injured Victim Do If Their Insurer Claims a Subrogation Lien?

What Should an Injured Victim Do If Their Insurer Claims a Subrogation Lien?

A subrogation claim can throw a spanner into the payout of an injured victim's personal injury settlement proceeds. The affected party can take the following steps to ensure a smooth process:

Seek a Copy of the Health Insurance Policy

An injured victim should get a copy of their health policy and go through its terms and conditions to search for whether or not their insurer has the right to subrogation or reimbursement. Failure to mention that in the policy language can bar the insurance company from making a personal injury recovery.

A skilled catastrophic injury lawyer in Nashville can help go through the insurance policy and identify any language that may assist in determining the insurer's right to recovery.

Review the State Insurance Laws

Every state has its own rules regarding subrogation claims. Some limit the insurer's rights to recovery, while others completely prohibit them from seeking repayment. There may be one law pertaining to Florida personal injury cases and another for claims filed in Missouri.

In Tennessee, the law allows the healthcare insurance company to pursue a subrogation claim or a reimbursement claim to recover the medical costs they've covered on behalf of its policyholder.

If an injured party is not sure about their state insurance laws, it's best to reach out to a skilled attorney for legal guidance. They may also want to reach out to an attorney to explain an injury lawsuits for std infection.

Determine Any Unrelated Medical Expenses

An injured victim should ask their health insurance provider for a list of itemized medical expenses related to the accident and start reviewing each one carefully.

Under the law, insurers cannot seek reimbursement for unrelated medical expenses, which means that the affected party can ask the insurance company to remove these types of medical costs from the final bill.

Negotiate with the Insurance Company

There is always room for negotiations, and the insurance company understands that. Injured victims should negotiate with the health insurer to ensure that they get to keep maximum settlement after paying the lien claims.

Below is an example to help illustrate how negotiations can maximize settlements for the injured victims:

Jack suffers injuries in a serious car accident and incurs $400,000 in medical expenses. His health insurance company covers the bill while Jack pursues a personal injury claim and recovers $1.5 million with the help of an attorney.

Assuming that the attorney charges 33% ($500,000) and the case expenses stand at $200,000, Jack is left with $400,000 ($1,500,000 - $500,000 - $200,000 - $400,000) after paying the lawyer, case expenses, and the lien.

If Jack is able to negotiate with the insurance company and brings the payment down to $200,000, he gets to keep $600,000 instead of $400,000!

Injured Victims Should Get Help from Schuerger Shunnarah Trial Attorneys!

Subrogation and reimbursement claims can be extremely complicated to understand, and there may be state and federal laws to consider. This can affect the victim's personal injury settlement. They can give insight to health care provider claims on personal injury settlements as well.

Those who are facing subrogation or reimbursement claims against their personal injury settlement in Nashville, Tennessee, should call to schedule a free consultation with Schuerger Shunnarah Trial Attorneys. They can help guide them through the legal process.


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