Subrogation of Health Insurers—What Does it Mean?

Published on May 14, 2019 at 3:31 pm in Car Accidents.

After a serious car accident you weren’t at fault for, you’re likely left with injuries that will need care. Since you weren’t responsible for the accident, insurance will cover your medical costs. However, you may find later that you’re being asked to pay some of those costs back. Subrogation of health insurers is a complex matter and you should have a professional at your side when this matter arises.

Subrogation Explained

The definition of subrogation states that it’s the third-party recovery of medical costs that a benefits plan paid for. It typically comes up after someone’s personal injury case has reached a settlement. They’ll get notified from their health insurance company claiming that some of their settlement should be paid back to them. This can be confusing to most, because they think it’s the insurance company’s job to cover medical costs. While they did do this, they can also make a claim for reimbursement. They have the right to do this because they paid your medical costs.

Since another person caused your injuries, you sought compensation from them. For the insurance company, they would not have had to cover your medical costs if that person hadn’t acted negligently. So, when you get a settlement because of the negligent party, your insurance will ask for reimbursement when you have those funds.

This is often a surprise to most people and they may not know the best way to proceed. You should always take steps to make sure you’re doing what’s right for you. Legally protecting yourself is always an important first step when it comes to insurance claims.

How Can a Lawyer Help You?

When you’re in these complex financial situations, it’s easy to be overwhelmed with stress. You may consider accepting whatever expenses come your way because it’s easier than fighting them. But you don’t have to fight them on your own.

A dependable personal injury lawyer can help reduce costs of what you need to pay back to your insurance company. Their experience and knowledge of how insurance companies work in these situations will give them the tools to negotiate with them and could end up saving you a considerable amount of money. Your attorney will also know if what they’re asking for is reasonable. It’s not uncommon for an insurance company’s request to lean on the higher side. Your lawyer may find that the insurance company is asking way too much of you and will work to bring that total down to a cost that makes sense and you can afford.

Your attorney will also know about the Made-Whole Doctrine, which can possibly defend you from having to pay back the insurance company. Subrogation cannot happen until you are fully recovered or “made whole.” Another way to think of it is that before subrogation is allowed, your health should be as close to what it was before the injury happened. The insurance company will have to show that you were made whole for subrogation to occur.

With a lawyer at your side, they’ll be able to explain to you what the insurance company is asking of you and why. But they’ll also determine if you can contest it or negotiate it to a smaller amount. These matters take time and they’ll deal with the insurance company so you don’t feel like you’re taking on too much at once.

Belsky & Horowitz, LLC Is Here for You

Our personal injury attorneys help many Maryland clients and will always fight for their rights. When you’re dealing with subrogation, you should have someone who is looking out for your best interests. You don’t have to worry about intimidation or being pushed into making quick decisions that you’ll later regret. We’ll go after insurance companies who are being unreasonable and can advise you on your legal options.

We want to help you settle these complicated matters so you can get back to your recovery. You deserve to have peace of mind and time to let yourself heal and possibly adjust to your new normal. To get started, you should get in touch with us as soon as possible. We’ll schedule an initial consultation where we can go over your case and figure out how to move forward.



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