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I had neck surgery due to a car wreck (not my fault). If I settle with her insurance do I have to repay my health insurance?

Maiden, NC |

I had to file my health insurance because Met Life Auto would not pay any money up front for the doctors office, prescriptions, x-rays, hospital cost, etc. She has car insurance of $30,000/$60,000/30,000 per person. Our car was fixed for $600 but I had to have C5-6 Anterior Cervical Diskectomy and Fusion. Her insurance says that they will only pay the $30,000 but the total bills are well over that (hospital alone is $42,000) if I have to reimburse my health insurance. I just don't want to get left holding the bag......Thanks

Attorney Answers 6


  1. You likely will have to pay your healthcare providers. Many healthcare providers file a medical or healthcare provider lien against any judgment or settlement you may receive. However, the providers usually are willing to settle their claim for pennies on the dollar (for example, 50 cents on the dollar or even 30 cents on the dollar). So when contemplating settlement, you need to keep this in mind.

    Consult a personal injury lawyer in your state to help you ascertain how much your case is worth. If the other car was at fault, a $30,000 settlement offer on a case involving $42,000 in medical expenses sounds low. If the case is worth more than what is being offered, consider decling the settlement offer. However, I do not have enough information regarding your case and make no judgment regarding this.

    Disclaimer: This response is for information purpose only and does not constitute a legal advice. This response does not create an attorney-client relationship.


  2. There are several things to take into consideration in this scenario. First, if your health insurance is not a self-funded ERISA plan, then I do not think they will be subrogated to your recovery because NC law prohibits subrogation by health insurance companies. Second, if you are married, then your husband has a potential claim for loss of consortium due to your injuries, and that could tap another $30,000.00 of the policy. Finally, under NC law the medical providers can only get a maximum of 1/2 of whatever is left after attorney fees. Thus, if your attorney gets 1/3, then that leaves 2/3 to split between you and the medical providers. No matter how high your bills are, the providers cannot get more than $10,000.00 from your $30,000.00 insurance maximum. I hope this helps. You really need a lawyer to help make this work out as it should.


  3. You should engage a personal injury attorney immediately. It appears that you have been offered the policy limits of the liability policy. If you had insurance at the time, you may have underinsured motorist coverage. You must consider that if you accept the offer you will likely be required to sign a release of all claims against the liable party. This would prejudice your right to sue the liable party for damages beyond the policy limits. Additionally, settlement will prejudice your own carrier's ability to recover payments from the defendant and could void otherwise valid underinsured motorist coverage. It is therefore important that you speak with an attorney before agreeing to anything. An attorney will also be able to negotiate with your health insurance provider.

    Adam Russell is an attorney licensed in Kentucky and Ohio. In accordance with Avvo community guidelines, this communication is for general informational purposes only and does not constitute legal advice. Nor does it create an attorney-client relationship


  4. This is too serious of a matter not to retain a personal injury lawyer to protect your rights. Medical bills can be negotiated down by the lawyer.


  5. If your health insurance company is an ERISA self funded plan you may in all likelihood have to protect their interests. Consequently, you should not settle with anyone unless this question is answered.

    Moreover several other questions should be answered? Is this all the coverage out there? Did the woman have an Umbrella policy to provide coverage? Was she on the job at the time such that her employer's coverage may come into play? Was there alcohol involved...then perhaps the bar's coverage may come in? Finally, do you have Underinsured motorist coverage on your own policy such that it would provide for additional coverage beyond the woman's 30k? More questions I'm sure, so bottom line is that you can't settle anything just yet. You need a lawyer!

    Worst case scenario is that you can negotiate the Health carriers lien down if that is all the coverage out there. Hope this helps.

    Bob Armstrong


  6. Please contact an experienced injury attorney to help you. There are ways to make sure you get the most money possible from the insurers including looking for UIM - underinsured motorist - coverage. Given your serious injury, you need a lawyer to handle the case, in my opinion. We are glad to talk without any charge or obligation to see if you want our help. 800 752 0042. John Cooper