Wow, that was a horrible accident. Thank goodness you had health insurance, they will take care of everything you need, right? Think again!
With the rollout of the Affordable Care Act, health insurance is in the news now, more than ever. And millions more Americans are expected to have health insurance in the future than have had insurance in the past. But how does health insurance work if you have been injured in an accident that was caused by the negligence of someone else?
You may be surprised to learn that, if you are hurt in an accident, your health insurance company WANTS you to bring a legal claim against the person or company that caused your injuries. Most insurance companies even REQUIRE you to bring such a claim, as a condition of your health insurance policy. This makes sure that the company or person who caused your injury is held fully responsible for the damages that they caused, and your health insurance company does not have to bear the cost of someone else's mistakes.
Hidden within the fine print on most health insurance policies is language that requires you to file a claim against the at-fault party who caused your accident, and then to share the proceeds with your insurance company, through a process known as Subrogation. And if you fail to bring a legal claim, your health insurance company might be able to stop paying for your medical care altogether, or to charge you for the cost of the care that you received. The insurance company relies on you to pursue such a claim, since you are the only one who can do so.
There are more reasons that you should file a personal injury claim. Even if health insurance initially paid your bills, there are other damages -- such as lost wages, physical impairment (all the stuff you couldn't do while you were hurt) and physical pain and suffering -- that health insurance simply doesn't pay. Plus, many hospitals may even refuse to bill your health insurance (or list them as a secondary (backup) payor) because the hospital would rather have the bigger payment they get from treating you as a cash patient (rather than a health insurance/Medicare/Medicaid patient).
Your personal injury attorney will work with you to make sure all of the medical bills related to your accident are paid out of any settlement or judgment that you receive, to see that your health insurance is paid back, and that you receive fair compensation for the damages that you have suffered.
Subrogation -- repayment of health insurance, Medicare, or Medicaid -- is one of the quiet secrets of personal injury cases. Even though it is a legal requirement, many people do not realize that it is the law. Courts in most states even have special rules that prevent juries from learning whether there is health insurance coverage in a specific case, or that the health insurance plan has to be paid back.
If you are on a jury, please remember that, even if health insurance might have paid some of the medical bills, health insurance most often has to be paid back. It is not dishonest, unethical, or "double-dipping" to file a personal injury claim when health insurance, Medicare, Medicaid, or worker's compensation may have initially paid some of the bills. Filing a personal injury claim allows responsibility for those medical bills to be placed where it belongs -- with the person or company that caused the injury.
Robert S. Hogan is an attorney licensed to practice in Texas, New Mexico, and Colorado, and is Board Certified in Personal Injury Trial Law by the Texas Board of Legal Specialization. This article is meant for informational purposes only, and not to be relied upon for legal advice or representation.
© 2013 Robert S. Hogan, Hogan Law Firm, PC, 1801 13th Street, Lubbock, Texas.