Reading the fine print in your health insurance policy can pay off, especially if you find yourself injured due to the negligence of someone else. This is because health insurance companies (and other entities, such as government agencies) can essentially assert a claim against your personal injury settlement in some circumstances. If the company paid for your medical bills, they can file a medical “lien” (or demand for repayment) against your case. This is sometimes discussed in health insurance contracts under the term “subrogation.”
Lack of Fairness
In some instances, these liens make sense; in others, they are simply unfair. Individuals typically pay a monthly fee associated with their health insurance coverage and this amounts to a hefty sum over the years, whether the insurance company ends up paying out for the cost of care or not. If you are then in an accident due to someone else’s negligence and end up needing a lot of medical care, how is it fair that your insurance company can now collect additional money from you based on any claim you win against the negligent party responsible for your injuries and medical costs? Shouldn’t coverage of your injuries already be included as part of your monthly premium?
Profits… for the Companies
Pennsylvania, like many other states, allows health insurance companies to seek recovery under these circumstances. But is anyone monitoring these claims to see what kinds of profits health insurance companies are making? And would monthly premiums necessarily be justified in going up if health insurance companies were not allowed to do this? Health insurance companies are already netting billions of dollars in profit each year.
Impacts on Smaller Claims
These liens can have major impacts in the smaller personal injury cases—especially for individuals who do not have an experienced attorney assisting them to help negotiate the liens down—necessitating the need for anti-subrogation statutes in each state to protect plaintiffs in these cases.
Another reason why it is crucial to have an experienced attorney helping you when you are injured is that hospitals themselves and workers’ compensation will sometimes have patients sign a lien letter. In these instances, your attorney can get the claims reduced.
Prohibition on Auto Insurance Companies
In the instance of auto accidents, auto insurance companies are actually prohibited from recovering medical expenses paid due to an accident. However, if your expenses exceed your medical expense benefit on your auto insurance policy, then health insurance must kick in to cover the remaining expenses, and HMOs and other health plans can recover money paid on your behalf as an accident victim.
Personal Injury Attorneys Serving Philadelphia & Surrounding Areas
Time is of the essence in all personal injury and related issues. Hiring a skilled attorney as early as possible better ensures that you are able to recover against other parties and negotiate with the relevant insurance companies. The experienced attorneys at Solnick & Associates LLC can help. Contact us today for a free consultation. We look forward to discussing your case.