We are about to settle personal injury claim ...there is no subrogation interest, claim or lien from health insurance company yet and we are about to settle personal injury claim ...after we settle the claim ...can health insurance company ask us to give them some money even though they don't have any interest as of now? how can we protect ourselves again any possible recovery/ interest from them?
For health insurance plans that are governed by Washington state law, there are provisions for reducing or eliminating obligations to reimburse health insurers (Common Fund Doctrine, Made Whole Doctrine) when circumstances warrant it.
For those governed by Federal law, more specifically, those that are fully funded by your employer, getting health plans to agree to any kind of compromise becomes very difficult.
As the others have said, it is unwise to continue without help.
You need to meet with a Washington lawyer. The first issue that lawyer needs to know is whether your health insurance comes from employer sponsored ERISA plan or is a private plan not related to yours or your wife's employment. The recovery rules and liens available for private plans depend upon the language of the private insurance contract and, as pointed out my one of the other attorneys, Washington law provides various ways to negotiate down the amount of reimbursement owed. As for ERISA plans, the law has changing and has become more favorable for people in your shoes but each situation needs to be evaluated individually. There are many excellent plaintiff's lawyer in the Tacoma area. Go to the WSAJ website and find one in your area. Good luck.
Who is telling you that the insurance company does not have any interest in the settlement proceeds? If you are relying solely on the fact that they did not file a lien, you may be sorely mistaken.
Insurers almost always have rights to reimbursement from settlement proceeds, and those rights are usually not dependent upon a lien having been filed. For example, the plan or contract will typically require reimbursement.
Bottom line is that, if you didn't pay the medical expenses yourself, you probably have a reimbursement obligation. I suggest that you consult with an attorney. Not only can he or she negotiate with the health insurer for possible reduced reimbursement, he or she will most likely be able to shake far more money out of the enemy than you can on your own.
First, I am out of Tacoma and would be happy to look at your case. Second, did you inform you health insurance of your claim? If you have not, your gut instincts are correct because a company cannot file a lien if they do not know that you have a claim. Lawyers like myself let every party with a possible subrogation claim know that a claim has been filed right from the start.
Finally, as someone pointed out already, we can virtually guarantee you that you are not settling for what you deserve if you are doing this alone without the help of an attorney. Good luck.
I agree with the previous answer. It sounds as though you could greatly benefit from consulting with an attorney. In response to your question though, in most areas, health care providers, and other interested parties, can attempt to recoup the money owed them after you settle. One way to avoid unexpected claims for money is to have these parties sign a release identifying that they are no longer entitled to subornation, or that they are fully paid.
You may very well want to contact an attorney about this issue. Just because the providers haven't filed a medical lien on your case does not mean that they do not have an interest. You do not want to end up in a position with your personal health insurance coming after you because you've settled a personal injury case and they did not have their interested tended to. Additionally, how are you aware that they do not have an interest or have not filed a lien?
Because you are getting ready to settle I would urge you to contact an attorney who will be able to give you a better idea if you are settling for an appropriate amount, and if there are any other claims that may need to be satisfied with the settlement proceeds.
The real question is, did your health insurance company pay any bills related to the personal injury matter? Just because they have yet to assert a right does not mean they do not have one. If they never paid any medical bills related to the incident then they would not have an entitlement to recovery. However, if they did, than they do have a right to recovery. Nevertheless, these types of recoveries, if not ERISA based, can often be negotiated. The easiest way to know if they have an interest is if you have updated medical bills from your case. Those bills reflect payments made. That is how you know what was paid and how much. If you do not have a personal injury attorney looking at this matter, you should. The last thing you want is a lien filed against you based on a misunderstanding.
The law varies from state to state, but generally speaking, most major health insurance companies do have a subrogation clause in their policies that require repayment of medical bill paid by the company from any settlement or judgment. There is also federal law that covers this if it is what is called an ERISA policy. It is very important that you make sure your attorney has covered this as if you are not properly protected by an subrogation agreement with your carrier, the carrier my sue you demanding the full amount of the paid medical bills. Be careful.
These are all good questions which your personal injury attorney should be able to answer for you. Are you represented?
If your health insurance company paid any of your auto accident related bills, they most likely already have a lien claim against your recovery under the terms of your insurance contract with them. Pull out your insurance contract and look for the section that deals with subrogation. You will find your answer their.
If you are not represented by an attorney, I suggest you seek representation or at least a consultation before you make any final decisions regarding settlement.
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.
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