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Can my medical insurance ask for reimbursement for bills they paid for me after a car wreck.

Austin, TX |

I was in a car wreck, auto policy paid me a lump sum and said I could use it for anything,. They said it was for pain and suffering and I could use it for med bills. Now my medical insurance wants me to remimburse them for the same amount my auto insurance paid me. They first wanted the total amount of bills they paid then came back and said they would take less than half.

Attorney Answers 4


Please tell me you have a personal injury attorney to deal with this. Are you telling us you have settled a first party claim with your own carrier and the medical bills were not addressed?

You need to consult with an attorney pronto. Good luck.

In no way am I offering you legal advice, and in no way has my comment created an attorney-client relationship. You are not to rely upon my note above in any way, but insted need to sit down with counsel and share all relevant facts before receiving fully-informed legal advice. If you want to be completely sure of your rights, you must sit down with an experienced criminal defense attorney to be fully aware of your rights.

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Virtually every health insurance policy has a "third-party reimbursement" clause, which states that if you are injured due to someone else's negligence, and then you make a liability claim against that person or his/her insurance, then the health insurance company is entitled to reimbursement from the settlement of amounts it paid for your medical care for the injury

Depending on state law, and the type of insurance plan that you have, there may be limitations and even complete defenses to reimbursement by the insurance company. In California, the insurance company can take no more than half, of a settlement by statute, and there are equitable doctrines that say if your not fully compensated by the settlement, the amoutn of reimbursement is greatly reduced or eliminated.

If you had an attorney, you should of course be discussing this situation with him/her. Otherwise, you may need to talk to a Texas personal injury attorney to understand your rights.

Good luck.

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This is one example of why you should always hire a lawyer to handle your personal injury case. Most likely, your health insurer does have a right to get reimbursed from your settlement with the at-fault party. In many circumstances, your health insurance company's right to reimbursement may even be superior to your rights to the settlement proceeds. Your lawyer would have identified these issues prior to agreeing to any settlement. If you signed a release, then you're probably stuck with the amount you settled for and just have to do your best in working with your health insurer on their reimbursement claim.

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Welcome to the wonderful world of subrogation. You need to request a copy of your health insurance plan or at the very least the plan summary documents. Almost every plan has a right of reimbursement when the treatment was the result of a thrid party's negligence. If the plan is an ERISA based plan, you very well could owe the entire amount or face being sued by your health insurance company and losing your coverage. In Texas, the Supreme Court has bascially done away with the made whole and common fund doctrines. Good luck and at the end you should likely pay them back the less than half number. You should contact your state representative and state senator and let them know about your situation. I guarantee that if you have a year you don't make a claim they won't reimuburse your premiums.

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