Role of Health Insurance Claim In Personal Injury Settlement

An injured victim with health insurance can use that coverage to payoff medical bills, before finalization of settlement terms. Yet that benefit comes with certain expectations.

Expectations of health insurance provider

That agency expects to be reimbursed for the money that it gave to the doctors and other medical facilities, while the injured policyholder was receiving the necessary treatment. The agency anticipates payment of the deserved funds, once the disputing parties have agreed on settlement terms.

Details of process that ensures delivery of expected payment

The insurance agency that has paid the medical bills sends a letter to the claimant’s attorney, and seeks details on the injury-causing accident. The same agency must show that the policy of the injured victim has authorized subrogation. That is the process that entails repayment of those that have covered a victim’s medical bills.

It is the attorney’s job to make sure that the state in which the accident took place allows subrogation of money obtained, following an accident. The same injury lawyer in Scarborough requests a list of the paid medical benefits.

The claimant’s lawyer takes from the client’s award money the amount of money that must be paid to the provider of health insurance. After paying the provider of health insurance, the lawyer takes his/her contingency fee from the client’s awarded funds.

At that point, the remaining funds are placed in a checking account, so that the client can receive a settlement check.

Circumstances that could alter the timeline in the process that was outlined above

The client’s lawyer might discover that the policy purchased by his/her client did not authorize subrogation. If that were the case, then there would be no need to remove from the client’s award the money that would equal the size of the insurance agency’s lien.

In other words, once the lawyer’s contingency fee had been removed from the compensation, then the rest of the money would go directly to the client, the recovered victim. That would reflect adherence to the terms of the client’s health insurance policy.

By the same token, the client’s legal counsel might discover that the state in which the accident took place did not allow subrogation. That discovery would, again, alter the procedure that would normally be used by personal injury lawyers. In other words, the provider of health insurance coverage would not have any legal grounds for demanding reimbursement of the provided coverage.

As indicated, it is the job of the health insurance provider to come forward with a listing of the paid medical benefits. If it were unable or unwilling to share that list, then the legal counsel for the policyholder/victim would not be bound to pay off the agency’s lien.

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