Do I Have to Pay Back My Private Health Care Insurance from my Car Accident Settlement?
Oftentimes Yes, if allowed by the express terms of the insurance contract.
Sometimes a private health care insurer will demand reimbursement, called subrogation, from the injured party’s personal injury settlement proceeds. Sometimes the insurers do not know about it. Sometimes the company’s claims processors are trained to look for and flag medical treatment codes and police reports that indicate a possible personal injury settlement. In Utah, once a claim is identified as a possible personal injury case, they often send the personal injury lawyer a notice of lien, requiring the attorney to reimburse the health care insurer from any settlement funds. This requirement for the injured party to reimburse their private health care insurer is based on the one-sided insurance contact between the insured injured party and the insurance company. The requirement to reimburse your health care insurer is based in contract law.
When you are injured in a car accident, your Utah automobile insurance policy will generally cover the first $3,000. This is personal injury protection (“PIP”) benefits and they are part of every Utah car insurance policy. PIP are no-fault benefits. Your car insurance is the primary medical bill pay coverage for car wrecks, unless you were on the job at the time, then Workers Compensation is the primary medical care coverage.
After you exhaust your car insurance personal injury protection benefits or Workers Compensation, then an exhaustion letter is sent to your private health care insurer and they will begin to cover the medical bills caused from the car collision.
Because your private health care insurance is a contract of insurance, there will often be a clause requiring mandatory reimbursement from your personal injury settlement. If on proper notice, your personal injury attorney will be required to withhold a portion of your personal injury settlement to pay back your private health care insurer. If the attorney for the injured party does not pay back the heath care insurance company, the personal injury attorney and injured party risk being sued for the money. And you can be assured that there will be an attorney’s fee clause for the prevailing party, so the risk is great. This just happened in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, 135 S. Ct. 1700 2016.
Often your Provo personal injury attorney can ask the private health insurer to reduce it’s lien to reflect the attorneys time in obtaining the lien money for the insurance carrier.
Liens are a serious matter in personal injury cases. Any worthwhile Provo personal injury attorney is constantly looking for liens and trying to avoid them, reduce them or at least timely get them paid.
If you have a car accident case you would like attorney Jacob S. Gunter to review, call him at (801) 373-6345.