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If you are injured at a hotel, and a settlement is offered, do you have to pay back the money paid by your insurance company?

Bradenton, FL |

My ankle was broken at a hotel due to wet floors and no warning device. They are offering to settle before we go to court. Will I have to pay back the insurance company for the money they spent for my ankle surgery and hospital stay? I need to know so that I will make sure I get enough for them in my settlement. Thanks!

Attorney Answers 8


  1. If you are represented in this matter the best option is to discuss this issue with your attorney. Generally speaking, health insurance companies typically have a right of subrogation or reimbursement set forth in the terms of the plan or policy. This means that if you make a recovery your health insurer may indeed want to be reimbursed for any money it has paid towards your accident related medical bills. The extent of the health insurer's right to reimbursement will depend on several factors that would really require analysis by an experienced attorney. The amount of repayment may also be subject to negotiation depending on certain factors. Good luck to you.

    The information provided by me should not be considered legal advice and does not establish an attorney-client relationship. I am licensed to practice law in Florida and you should consult with an attorney in your area for legal advice. The information exchanged on avvo.com is not privileged and you should not share confidential information over this forum.


  2. You do not say whether you hVe retained an attorney. If not,you should. Your health insurance provider may assert a lien against funds rreceived from the tortfeasor. This amount is usually less than the actual medical bills and may also be negotiated downward at times. Please contact a local atty to discuss in greater detail. Fee free to call me at my office.


  3. Many insurance companies have a right of reimbursement against any third party recovery - it depends on the wording in your policy. An attorney can negociate this amount. Sometimes in a difficult liability situation & based on the the amount of proposed settlement convince the carrier to completely wipe out their lien. You really need to seek the advice of a good FL personal injury attorney who will be able to review the amount of your proposed settlement & deal with the potential lien.

    This is not intended to be legal advise or as legal representation. I am a California personal injury attorney . Be aware that every state has its own statute of limitations; and statutes & case laws that govern the handling of these matters.


  4. Like others have mentioned, if you are represented, you probably should be discussing this with him or her. Generally group health carriers will have a right of subrogation against any settlement/judgment received. Depending on the policy in place and type of insurer, it may be at 100% or something less. If you don't have an attorney, I would definitely consult one prior to signing any release and agreement to settle. Feel free to call my office if you have any further questions or wish to discuss the same in more detail.


  5. Almost every health insurance contract has a provision for at least partial re-payment of monies paid for medical expenses caused by an accident for which you get a settlement or judgment. I say "at least partial" as some carriers (usually those who issue policies thru your work and are considered ERISA policies) claim a 100% reimbursement. this has become an increasingly complicated area of the law in recent years as carriers have become more aggressive in pursuing their rights.
    I can't tell if you are represented or not. If you are,the reimbursement or subrogation lien of your carrier should be throughly explained and discussed with you before any final settlemnet.


  6. Your lawyer should be able to negotiate liens down to 5-10 cents on the dollar, but make sure you don't sign the release until this is resolved, otherwise, there will be no incentive to do so.


  7. Your health insurance policy likely contains a clause requiring you to notify the insurer if you are getting medical treatment for injuries caused by another person so that your insurer can pursue recovery of amounts it paid for those expenses. Note that if you are done with your treatment, you can try to negotiate a lower payment to your health insurer and most insurers will accept less than the amount that they are seeking. I would not settle your case until you know how much your insurer is going to seek. Also, the hotel may have no fault medical payment insurance that will also pay at least part of your bills. Ask them if they do


  8. Every modern health care insurance policy I have reviewed in the last 10 years contains a subrogation clause, which means that most probably you will need to reimburse them for moneys they have already paid on your related medical bills. Your attorney should review your insurance policies.

    The subrogation issue is one which you should discuss with your attorney. He may be able to negotiate a reduction in the lien claims, prior to accepting a settlement amount, which will then help you calculate what your net recovery might be should you accept a certain amount. Discuss all of this with your attorney.

    Legal Disclaimer:

    If this information has been helpful, please indicate below.

    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.

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