How Health Insurance Companies Seek Repayment of Money Spent On Medical Care?

The provider of funds for an accident victim’s medical expenses, during that same person’s recovery, has a claim to money from the any negotiated settlement. How are such claims handled?

Subrogation notice

Subrogation is the term used in reference to health providers’ claims. A given provider of health insurance would be expected to send a subrogation notice to an accident victim that had enjoyed the payment of medical expenses. In that same notice, the company that had covered the cost of the medical expenses would ask several questions:

-Was your injury work-related? An exception can be made to a state’s possible prohibition of the subrogating process, in certain situations, namely, where there has been a work-related injury.

-Was there a 3rd party involved in the accident? The carrier would seek that information, in the event that the at-fault party did not reach a settlement with the accident victim.

-What was the name of the insurance that was held by the at-fault party? A health carrier does not want to feel dependent on one party’s claims, with respect to the size of or timing of a payout.

-What is the name and contact number of any personal injury attorney in Niles that you have hired, for assistance with this particular personal injury case? If the attorney failed to contact the health carrier, then that same carrier would need to contact the attorney.

Rules that apply to subrogation

Some states prohibit health insurance carriers from carrying out subrogation on settlements that have been received by the claimants or plaintiffs in a personal injury case. States usually make an exception to that prohibition if an employer has chosen to self-insure the health claims of the employees. Another way that a state law relating to subrogation might become of no consequence would relate to the possible issuance of a federal law. Federal laws on any issue always supersede state laws on the same issue.

No health carrier has an automatic right to pursue subrogation, unless the same carrier’s utilization of that particular process has been authorized by the health insurance policy of the person that has received funds, as compensation for an accident-related injury.

How do insurance carriers get reimbursed for the money that has been paid out?

Usually, a lawyer hired by the individual with the personal injury claim arranges for that payment. The money paid to the insurance carrier comes out of the funds that were granted to the injured victim, by way of compensation, or in response to a court-ordered judgment. In situations where a claimant has chosen to handle his or her own case, the same claimant needs to arrange for the payment of the insurance carrier.

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