I was in an accident 09/21/12 my health ins paid the emergency room bill? Will this effect what the at fault party pays out?

Asked almost 2 years ago - Lexington, NC

I was in a car accident in September and went to the emergency room and have been seeing another dr for treatment since the accident. During this time the hospitol billed my health insurance company and were paid in full. I am settling now with the at fault party. Where does the amount for the emergency room bill go? Will they be responsible to reimburse me if they recieved payment from both insurance companies? I have a total of $7,586 in medical bills what can I expect for settlememnt offer?

Attorney answers (7)

  1. John Locke Milholland IV

    Contributor Level 11

    8

    Lawyers agree

    Answered . Avvo Email - Rated Professionals. Expert Advice.You should speak to a lawyer in person or on the phone to fully answer your questions as there will be a lot of fact dependent scenarios at play. Generally, you have a claim for your medical bills. Your health insurance will often times pay what they cover, but they can sometimes assert a lien against a settlement in order to get reimbursed for what they have paid on your behalf. The Insurance company that insured the responsible driver is only going to want to pay once. They will likely get a complete release of liability at the time of settlement. If you have not made sure that you are satisfied with the amount you settle for given the claims at stake, you could lose your right to get anything else.

    ***Disclaimer***
    The above response does not create an attorney client relationship. The response is limited to the specific limited facts provided. Additional or different facts can, and likely would, lead to a different response. The response only applies to North Carolina, the jurisdiction where Locke is licensed to practice.

    **Disclaimer** I am licensed to practice in North Carolina. I practice out of Raleigh and Wake County. This... more
  2. Michael Scott Rothrock

    Contributor Level 15

    7

    Lawyers agree

    Answered . I agree with the other responses. Additionally, to address your question regarding reimbursement for medical bills more directly, if your accident occurred on September 21, 2012, then you are subject to our new tort reform law regarding medical bills passed by the elected General Assembly last year. Prior to October 1, 2011, if a person had $8,000.00 in medical expenses, they were entitled to claim at trial and potentially recover $8,000.00 in medical expenses, regardless of whether any of those expenses had been previously paid by an insurance company or any other collateral source. After October 1, 2011, a person can only claim and recover what has been paid and what is left to be paid. So, let's take the $8,000.00 example again. Let's say you have Blue Cross Blue Shield and BCBS pays $4,000.00 of that $8,000.00. You pay $1,000.00, and there's a $500.00 balance left on one of the bills. The remainder was written off by the provider as part of their contract with BCBS. Under the new tort reform law, you may only recover $5,500.00 in medical expenses, which represents the amount actually paid and left to be paid ($4,000 + $1,000 + $500). In regards to what to expect from a settlement offer, that is impossible to tell based on the information. You should consult with an experienced personal injury attorney in your area. Personal injury claims can be very complicated even when the injuries are not that severe, and sources of payment, insurance, liens, etc. can make it very complicated for an unrepresented person.

    This information is provided for general purposes only and should not be construed as legal advice. No attorney-... more
  3. David J. McCormick

    Contributor Level 20

    7

    Lawyers agree

    Answered . No one here can give you an opinion of what your case is worth just based on your medical bills. Also, you need to review your health insurance policy to see if your health insurance has written subrogation/reimbursement rights. This can be a tricky area of the law and you may want to have this reviewed by a local personal injury attorney to see what you are obligated to do.

    Good luck.

    DISCLAIMER: David J. McCormick is licensed to practice law in the State of Wisconsin and this answer is being... more
  4. William David Owens

    Contributor Level 8

    5

    Lawyers agree

    Answered . You mention a total of $7,586 in medical bills. Does this include the ER bill? How much was the ER bill? How much did your health insurance pay? How much did the hospital “adjust” or write off, as part of their contractual relationship with your health insurance company? Does your health insurance company have a right of subrogation to recover (from you) the monies they’ve paid to the hospital on your behalf? Does the $7,586 figure include diagnostic/radiographic testing? How much? What were the results? North Carolina law changed in October 2011, as it relates to the amount of medical bills the auto liability insurance company is obligated to pay as part of the resolution of the claim. Are there other insurances available, such as medpay? What was the nature of your injuries that required follow up with the Dr.? What kind of doctor did you follow up with (specialist/PCP/etc.)? Is further care needed? The answers to these questions (and many more) will impact the response to your original inquiry. I’d strongly recommend consulting with an experienced injury attorney BEFORE speaking further with any insurance company. You may very well be able to handle the matter on your own, but I’d at least get a free consultation before treading these dangerous waters alone!
    William Owens
    Owens & Miller, PLLC
    4030 Wake Forest Road, Suite 101
    Raleigh, NC 27609
    Phone no: (919) 719-2750
    Fax no: (919) 516-0063
    www.owensmiller.com

  5. Christian K. Lassen II

    Pro

    Contributor Level 20

    5

    Lawyers agree

    Answered . Don't try to settle without a lawyer, or you will get kicked in the teeth, and receive a tiny nuisance settlement at best. A good personal injury lawyer will negotiate any medical liens down to 5-10 cents on the dollar, so you aren't stuck with bills and ruined credit after you settle your case.

    Only 29% Contingency Fee! Phone: 215-510-6755 www.InjuryLawyerPhiladelphia.com
  6. Jeffrey Mark Adams

    Contributor Level 20

    4

    Lawyers agree

    Answered . I will add that you can expect less of an offer than without an attorney and more of an offevwithvan attorney; almost always.

    Personal injury cases only; I'm good at it; you be the Judge! All information provided is for informational and... more
  7. Joseph A. Lowman

    Contributor Level 5

    4

    Lawyers agree

    Answered . First, in order to give you an accurate evaluation of the value of your claim, an attorney will need much more information than what you have provided thus far. Further, the evaluation should not cost you anything if the attorney provides a free consulation of your case. Keep in mind, it is very common for the insurance company to offer a lower amount initially and be willing to increase their offer through negotiations so you may not wish to accept the first offer.

    With regard to the emergency room charges, it is important to be sure the bill was submitted to your PIP carrier as they require the bill to be adjusted (reduced) and do not have a right to be paid back (right of subrogation) like your health insurance.

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