Subrogation. The word itself is strange and seems scary to the uninformed. However, it is a very common legal tool for health insurance companies to recoup monies that they have paid out when their insured has been injured due to the negligence of a third party, i.e. a car or trucking accident, dog bite, etc..
The experienced personal injury attorneys at Guest and Gray navigate the complicated field of subrogation on a daily basis in pursuing personal injury cases for our injured clients. We have represented injured parties in Forney, Rockwall, Dallas, Terrell, and all over East Texas in hundreds of personal injury cases.
In most cases, if you are involved in an accident, you go to the hospital and you provide your health insurance information and you think that is that. However, unbeknownst to you, that gives rise to a subrogation claim by your health insurance company and they are pretty quick to pick up on the charges due to the type of treatment and billing codes that are entered by the hospital or other treatment facility.
So, what happens next?
You get the letter. Usually it is from a company like Optum, Rawlings Group or Conduent. The letter has a scary look about it and it says that they believe that they may have an interest in your case due to amounts paid out on your behalf.
Oh, crap. Here we go.
Well, not really. All it means is that when negotiating with your insurance company, we need to take their interest into account. Depending on the type of interest they have (there are different types of health insurance plans and the type of plan it is determines how much they are entitled to be paid back out of your settlement). When you receive the letter, bring it to your attorney. This is important as your attorney will then begin talking with your insurance company about the type of interest they have (if they have not already done so) and begin working with them to figure out the claims that they have.
WHAT ARE THE DIFFERENT TYPES OF SUBROGATION INTERESTS AND HOW COULD THEY AFFECT MY RECOVERY?
To keep things simple, lets group the health insurance subrogation interests into two categories: claims subject to state law (these are the best) or claims exempt from state law by a federal law, i.e. ERISA health benefit plans, Medicare/Medicaid, Tricare, etc.. (these are not so good).
Claims that are subject to state law, are limited in there recovery to a maximum of 1/3 of your total recovery. This means that if you settle your case for $30,000, the most they can seek through subrogation is $10,000. This is true even if they paid out $500,000 on your behalf. $10,000. That is it.
Now, those federal plans, if they paid out $500,000 on your behalf, how much are they entitled to recover? $500,000. See how that works? State law does not apply because federal law preempts state law. Sucks right? I know.
So, lets throw a wrench in this thing. What if there is only $30,000 in insurance coverage but your insurance company has paid out $500,000. Yikes! If you accept the $30,000 your health insurance company is just going to walk by and snatch that check right from your hands. What if you have other unpaid bills (which happens ALOT)? What happens to your claims for pain and suffering and mental anguish, etc.. It seems like you get nothing. That kinda sucks. So, what do you do?
Answer: Call Guest and Gray Law Firm, P.C. Our experienced personal injury attorneys have successfully negotiated with federal plans on hundreds of cases and worked out ways to ensure that our clients walk away with funds at the end. Not only do we fight hard against the negligent driver’s insurance company, we also work with the providers and health insurers to make sure that they don’t walk away with all of your money. After all, you were the one who got hurt here. Not them.
So, if you have received one of those scary letters from your insurance company after an accident, give Guest and Gray Law Firm, P.C. a call today. We will begin working with your insurance company and the at-fault insurance company to get you the compensation you deserve. Don’t wait, Call Today! (972) 564-4644