I receive a 15,000 dollar settlement from the insurance company for an auto accident. my lost wages are 14,000, med.

Asked almost 2 years ago - Downey, CA

bills are16,000(have HMO coverage) plus pain and suffering.Can my med. insurance require me to pay the full 14,000 back?

Attorney answers (3)

  1. Jeffrey Michael Padilla

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    Answered . It sounds like you did not engage an attorney to represent you in this claim. If that is the case then your health insurer's lien cannot exceed 1/2 your recovery. If they dispute that, direct them to CA Civil Code section 3040. If you did engage an attorney, their max lien would be 1/3 of the settlement.

    Once the lien is established, you are still entitled to reduce it further as they must share in your costs of securing the recovery. So, if you had to pay doctors to get medical bills or incurred any other charges as a result of pursuing the claim, you can get them to share in those costs.

    Finally, you can still review the health insurer's policy for language related to "third party recovery." In that section they will explain their rights when you get money from another person responsible for your injuries. If that language isn't clear, you can argue that you were not "made whole" by the policy limit recovery and therefore, they should not be able to collect anything.

    Good Luck!

    This response applies to California Law only and does not create any legal relationship between the attorney and... more
  2. David Vincent Hiden

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    Answered . No, they cannot. There are many laws that prohibit this but under most circumstances, you have to be made whole b/f the carrier can even start to request reimbursement. There are also deductions that can be made and other laws applicable, depending on whether it is an ERISA set of facts and other issues. Talk to an attorney who handles this area of law as it is specialized knowledge. Under these facts, you probably have a 90+% chance of making almost the entire lien or all of it, go away.

    Legal disclaimer: Please be advised that the advice provided does not create any attorney/client relationship;... more
  3. Thomas Anthony Schaeffer

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    Answered . Typically, the hospitals work under a medical lean on any settlement that may be reached. That said, they usually negotiate down the amount and can work with you on payments. If your bills are more than the settlement, then I'd suggest going after the person who hit you personally and/or filing a claim with your insurance agency under the uninsured/underinsured part of the policy (if you have that coverage).

    Good luck!

    Thomas A. Schaeffer, Esq. Law Office of Juarez and Schaeffer PO Box 16216, San Diego, CA 92105 (619) 804-4327 www.... more

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