Do I need to reimburse my health insur. comp. (or the dr.s they paid) for the treatment received from slip and fall?
Fell on ice at my apartment complex, done with treatment and about to sign waivers/get settlement check. Do I have to reimburse my health insurance (or will they take payment back and I need to pay doctors directly) out of my settlement check? No attorney involved at this time and have until 3/1/13 to sign.
Even with smaller cases it’s advisable to involve an attorney who will help determine early on what liens may exist and who can negotiate payment of those obligations as part of the settlement, even increasing the settlement to maintain or enhance the injured person’s net recovery.
Typically if an injured person has private health insurance through a larger employer then their coverage often times will be provided under an ERISA insurance plan. That ERISA (Employee Retirement Income Security Act of 1974) plan will have proper language that entitles the insurance carrier to priority reimbursement over an injured party’s settlement award. In other words your medical insurance gets reimbursed from your injury settlement for the money they’ve paid for your medical care related to your injuries BEFORE you get any money.
While many small employer plans are NOT ERISA insurance plans (i.e. they are NOT entitled to a priority lien) determining whether a plan is entitled to reimbursement or not can be a tricky inquiry. Most personal injury attorneys at the beginning of the case will write to the health insurance provider advising them of the potential personal injury matter and demanding it notify them the amount and basis for any claimed lien. If a lien is claimed then the attorney can negotiate the lien down and/or challenge certain charges that may not be related to the injury care (i.e. regular doctor visit, flu, unrelated injury, etc.).
Also beware that in Connecticut the DAS (Dept. of Administrative Services) Collections Recovery Unit pursues recoveries from windfalls such as lawsuits, inheritances, and the estates of deceased recipients for any individuals that have applied and received state aid from state run health programs (Husky Health / Charter Oak) - Medicaid / Medicare programs, from various state agencies departments of Social Services (DSS), Mental Health and Addiction Services (DMHAS), Children and Families (DCF), or Developmental Disabilities (DDS), and from persons sentenced to serve a jail term by a Connecticut court (incarceration). http://www.cga.ct.gov/2010/rpt/2010-R-0444.htm A request can be made to DAS whether any additional lien exists or not.
You should fully understand what liens may exist before signing anything and settling the claim. It is also not too late to involve an attorney for assistance in the case. Good luck.
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You will likely have to deal with any outstanding balances or liens that exist. Remember that often you can negotiate the balances with your health insurance and/or provders. Best of luck.
I am licensed in California, therefore, my answers are based on general prinicpals of law or California law, which... more
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What do you mean you are about to sign "waivers"? Generally a release document is signed prior to receiving a settlement check.
You may be doing yourself a disservice by attempting to handle this matter on your own. Are you convinced you are being compensated for all of your elements of damages? Do you know all of the elements of damages? You may find it helpful to review the Legal Guide I have published on Avvo.com concerning damage issues. You can access it through my profile page on Avvo.
Almost all medical insurance carriers have subrogation clauses in their contracts with you that require you to notify them about your settlement and also pay them back for the amounts they have advanced to pay your Dr. bills while you await recovery from the defendant. You can be subject to suit by your medical insurance carrier for failure to pay the subrogation lien claim and, depending upon the wording of the contract, you may also be obligated to pay them for their attorney fees in suing you, which conceivably could exceed the amount in controversy with them. There are certain setoffs which you may be able to advance against their lien claim and thereby reduce the pay back amount to them. Attorneys are familiar with this concept and how to do it.
At the very least, I suggest you obtain a free consultation with a personal injury attorney in your area before you make any decision to sign your name on a release.
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Mr. Lundeen is licensed to practice law in Florida and Vermont. The response herein is not legal advice and does not create an attorney/client relationship. The response is in the form of legal education and is intended to provide general information about the matter within the question. Oftentimes the question does not include significant and important facts and timelines that, if known, could significantly change the reply and make it unsuitable. Mr. Lundeen strongly advises the questioner to confer with an attorney in your state in order to ensure proper advice is received.
This ans. does not create an attorney/client relationship.
This can be a complicated situation. It depends in part upon the location of the accident, and the kind of insurance that you had for your medical bills.
You did not ask for advice about settling a claim without consulting an attorney, so I will not address that issue. As a general rule, however, if you have a question about your case it is good practice to get an answer from an attorney in whom you have confidence.
Since I do not know the source of your health insurance benefits, I cannot tell you if you have to reimburse your insurer or not. Generally, if your health insurance was provided by the State of Connecticut, then there could be a right for the State to be reimbursed if you are given notice of a lien. If your insurance came from a plan provided through an employer (your employer or that of your spouse or family member), then the issue is even more complicated because sometimes Federal law controls that question and sometimes it does not . Connecticut law does not allow a health insurance company to to assert a lien, but Federal law "preempts" state law on that issue and could require you to reimburse your insurer for the payments that it made.
Unfortunately, this is a complicated area and there is no simple, general answer. There are many lawyers who would be able to help you with your specific situation. You might also wish to contact the State of Connecticut's Department of Insurance. Good luck, and I hope your injuries have healed well.