Can I Use Health Insurance For An Injury Case?

A person who is filing a personal injury lawsuit might want to recover medical expenses, even if those expenses were paid for by their health insurance. There tend to be two important issues that arise in cases where insurance pays for the medical expenses. The first issue is the subrogation process. Most health insurance policies will have a subrogation clause. Generally, these clauses will state that the health insurance company will cover any medical care that its customer incurs as the result of an accident. However, if the customer then recovers damages from a third-party, that customer has to use those proceeds to reimburse the insurance company for what it paid.

The victim can recover the medical expenses that were paid for by insurance, but they will likely have to use the proceeds they receive to repay the health insurance company. Subrogation can be complicated because there can often be a dispute about exactly how much the victim has to pay back to the insurance company. There are several legal issues that govern this issue, depending on the particular facts of the case. A dispute over the amount that needs to be paid back can often take months to finally resolve.

The second common issue is the paid or incurred rule. Health insurance companies generally have contracts with certain doctors and other medical providers which will allow the insurance companies to pay those providers a discounted rate. For instance, a medical procedure may cost a person who does not carry health insurance $2,000.00. An insurance company will be able to negotiate the price to $1500.00. As a result of this system, when a person who does have health insurance gets this medical procedure done, the bill will state $2,000.00, but then there will be a contractual adjustment and the insurance company will only actually have to pay $1500.00 to pay for the procedure. This leads to disputes over which amount is required to be reimbursed. The best course of action, in this case, is to consult a personal injury attorney.