We had a slip and fall case against a store. My wife hade foot problems that required surgury that her health insurance paid. Because of different medical reports showing we could not win we settled for a small sum out of court. We have a independent report stating that her present problems do not have anything to do with the accident. Her former insurance wants 1/3 of the settlement. We were told because it is an Erisa plan they can demand this. Our question is, can we fight paying them as we can show that the settlement is for the fall not anything to do with her surgeries?
Car / Auto Accident Lawyer
Health insurance policies often have a clause that allows for subrogation. In other words, if you recover from a third party for damages that include medical bills paid for by the health insurance company they are entitled to a lien to get back the money paid in medical benefits. Typically, the lien amount is negotiable. However, if you have a report that shows the slip and fall accident is not the reason for the medical charges I suggest you forward that report to the adjuster for consideration. Also, ask the adjuster for the medical records they rely upon for their determination that the charges they seek to be reimbursed for related to the slip and fall. Once you have the information they rely upon you can make an informed decision regarding payment back to the insurance company.