Understanding Health Insurance Subrogation

August 13, 2013

Even though Florida’s PIP statute provides that the first $10,000 of your medical treatment is covered by your Personal Injury Protection coverage, there are many instances where the need for ongoing treatment results in the payment of medical bills by your health insurance carrier. Although your injuries may have resulted solely due to someone else’s negligence, your health insurance carrier may have a right of reimbursement (“subrogation”) from any money you may recover from the negligent party in a personal injury case.

Your health insurance carrier has an obligation to pay for medical treatment covered under the plan even if the treat is accident related. However, whether your health insurance carrier has a right of reimbursement is based on the specific terms of your health insurance policy/plan. Florida law provides that minimally, a health insurance carrier must reduce its claim for reimbursement at least by the pro-rata share of costs and attorneys’ fees incurred by the personal injury claimant in its effort to make the recovery. In other words, the health-insurance company entitled to reimbursement must discount the amount owed by the same percentage of the recovery/judgment that went towards attorney’s costs and fees.

Beyond that, there are various other factors that may determine how much, if at all, your health insurer is entitled to be re-paid.

In many cases, your health insurance carrier is willing to accept a reduced amount and we may be able to negotiate these reductions on your behalf. The health insurance carrier may take into account such issues as comparative liability between the Plaintiff and the Defendant, sufficiency of bodily injury coverage limits, existence of additional liens and/or claims for subrogation, and any other factor that may limit the Plaintiff’s recovery. Moreover, Uninsured/Underinsured Motorist claims are not typically subject to subrogation. If the insurance company will not agree to reduce/eliminate its claim for reimbursement, a “Declaratory Action” can be commenced whereupon a Judge will apportion the settlement.

Part of our firm’s job as your Tampa Bay personal injury attorney is to negotiate these claims for reimbursement as much as possible. This may include reviewing your health insurance policy to determine what exactly is reimbursable, and reviewing the payout ledger to make sure it includes only services related to the auto accident. Please call (813) 991-5099 of email personal injury attorney Charles Spinner, Jr. at cspinner@spinnerlawfirm.com for help with your health insurance issue.

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