Do I have to reimburse my insurance company for the medpay if I receive settlement from at fault insurance?

Asked about 2 years ago - Los Angeles, CA

Recently, I was in a car accident and the other driver's insurance carrier accepted full liability. I used my Medpay to pay the Doctor's bill. I am in the process of negotiating a settlement with the at fault insurance carrier and I'm being told by my own insurance company that I have to repay the medpay amount with the settlement money. Is this true?

Attorney answers (13)

  1. Jeffrey Michael Padilla

    Pro

    Contributor Level 13

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    Answered . As the others have already said, you likely will have to reimburse your med pay provider a portion of what was paid. This will depend on the policy language. However, there may be opportunities for you to significantly reduce your reimbursement obligation or even eliminate it all together.

    There are doctrines of law called the Common Fund and Make Whole which can help you in certain situations.

    If you are discussing settlement with an insurer, I would encourage you to contact a personal injury attorney before agreeing to anything. The insurer's job is to pay you as little as possible. A consultation would be free, but if you choose to engage an attorney I would expect them to pay for themselves by getting you more settlement funds and reducing your reimbursement obligations.

    It is also important to note that if you have health insurance and they made payments for your medical care as well, it is possible that they too could have the right to be reimbursed. Just another reason to consult a professional before agreeing to anything with the other party.

    Good luck.

    This response applies to California Law only and does not create any legal relationship between the attorney and... more
  2. Hadi Edward Ramsey

    Contributor Level 13

    11

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    Answered . Your insurance company policies and procedures would regulate the outcome. Generally, you are required to pay it back.

    ATTORNEY DISCLAIMER TO THE ABOVE ANSWER: The information that I have provided to you is for general information... more
  3. Asmik Jasmine Gevorkyan

    Contributor Level 12

    10

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    Answered . Look at your policy And see if there is a reimbursement provision. But generally there should be.

    The response given is not intended to create, nor does it create an ongoing duty to respond to questions. The... more
  4. Charles Jervis Mellor

    Contributor Level 12

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    Answered . I agree with my colleagues that most policies generally call for reimbursement. However, you may want to try to negotiate the with the carrier and try to reduce the amount of reimbursement. Particularly if the med pay disbursed did not cover the total cost of the care provided.

    The information presented here is general in nature and is not intended, to be construed as legal advice. This... more
  5. Jacob Adam Regar

    Pro

    Contributor Level 16

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    Answered . Contact a personal injury attorney and learn the full scope of your rights. It is not a good idea to handle these matters without legal representation unless you have spoken to some lawyers and they told you that the damages were small enough that small claims would be an appropriate forum to adjudicate your claim if you were unsatisfied with the insurance company's settlement offer.

    In CA, the statute of limitations for personal injuries caused by negligence is 2-years from the injury.

    And, yes, typically you will have to reimburse your insurer if you recover proceeds for your injuries from a third party. But, this may depend on your specific policy language. Look to your policy.

    This website contains general information about legal matters. The information provided by Jacob Regar is not... more
  6. John Robert Sauter

    Contributor Level 11

    10

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    Answered . It depends on the language in your insurance policy, but generally, yes, this is true.

    Disclaimer: This does not constitute legal advice. No attorney-client relationship has been formed through this... more
  7. Robert Adler

    Contributor Level 6

    7

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    Answered . The answers below are quite correct. However, carriers are often open to negotiating the amount of reimbursement. Definitely consult a personal injury attorney in your area to find out how this is done.

  8. Brian Anthony Carness

    Contributor Level 4

    6

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    Answered . It depends on the terms of your insurance policy. Usually, insurers will seek reimbursement if you recover from the at-fault party. However, in most instances, an insurer has a right to reimbursement only if the insured has been "made whole." In California, being "made whole" includes medical damages, past and future special damages, and general damages for pain and suffering.

  9. Steven Mark Sweat

    Contributor Level 19

    6

    Lawyers agree

    Answered . Every auto insurance carrier has a provision in their policy requiring reimbursement for med pay payments in the event that you receive recovery from the at fault party. This is usually subject to a "made whole" rule (i.e. that you must receive enough compensation from the settlement to pay for all present and future medical and other expenses as well as pain and suffering damages before their right to reimbursement kicks in). These liens are always negotiable and you should try to argue the "made whole" rule to negotiate the lien lower. Insurance carriers differ in how aggressive they are in pursuing payment on these liens.

    Nothing in this communication should be construed as creating an attorney client relationship. This is for... more
  10. Christian K. Lassen II

    Pro

    Contributor Level 20

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    Answered . It depends on the language of your policy, but in general the answer is yes.

    Licensed in PA & NJ. 29% Contingency Fee. Phone: 215-510-6755 www.InjuryLawyerPhiladelphia.com
  11. Steven Martin Campora

    Pro

    Contributor Level 2

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    Answered . The answer to your question is maybe. First, you need to look at your automobile insurance policy and find out if the policy provides that you must reimburse your insurance company if you settle your case. Not all automobile policies include such a provision. Second, you do not have to reimburse your insurance company if you are not "made whole," by the settlement. For example, let's say you had back surgery due to the accident and the person that hit you had only a $50,000.00 policy limit. If you accepted the full policy limit for settling your claim, you would not have been "made whole," because your case would have been worth more than $50,000.00.

    So, the answer is, (1) if your policy inlcudes a provision which requires you to repay your insurance company for medical payments, if you recover, and (2) if you receive the full value of your case in settlement, then yes you would have to repay your insurance company. If you have a lawyer, your insurance company would have to reduce the amount of the repayment by its share of the attorney's fees and costs.

    This response is provided without full knowledge of all of the facts and circumstances and is for informational... more
  12. Ryan Hugh Sargent

    Pro

    Contributor Level 9

    4

    Lawyers agree

    Answered . It depends on the language in your insurance policy. Also, depending on the circumstances of your damages and settlement, you may be able to get the med pay reimbursement waived.

    I would highly recommend discussing your case with a car accident attorney. Many people think that they are saving money by handling the claim themselves. Insurance studies have shown that injured victims with an attorney recover 2-3x more money than those who do not have an attorney.

    Legal disclaimer: The information provided is general in nature based on the limited information provided and does... more
  13. Jeffrey David Wolf

    Contributor Level 7

    2

    Lawyers agree

    Answered . The only addition I would make to the previous answers is that under California law you may not need to reimburse the med pay at all if the amount of the third party recovery is in excess of your underinsured motorist policy limit.

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