Do I have to pay my health insurance carrier back out of my settlement?
September 12th, 2011
The answer to this question is usually “yes.” Most health insurance plans contain a subrogation clause.
Subrogation is the right to be reimbursed for expenses paid on behalf of another. There are three types of subrogation: statutory, contractual and equitable.
Statutory subrogation is where there is a specific statute or Federal law that creates a lien of the payor against any right of recovery that the beneficiary has. Medicare and Medicaid are examples of government-funded programs that are entitled to subrogation against a personal injury claim by law. Additionally, hospitals providing emergency service in Texas and some emergency service providers have a statutory subrogation right to recover for services rendered to an injured party if that party recovers damages from someone else for the injury.
Contractual subrogation is where a written contract obligates someone to repay benefits if recovered in a personal injury action against another. Most healthcare insurance carriers include a provision in the contract that entitles them to this type of subrogation. Thus, you should always check your health insurance policy to be sure of your contractual obligations.
The third type of subrogation – equitable subrogation – is where there may be no contract but the law determines a party should be allowed subrogation as a matter of fairness. This clause can also be used in some circumstances to require reimbursement.
Have a Personal Injury Attorney Review the Insurance Policy
You should always double-check your health insurance policy and consult your attorney about the legal effects of any subrogation clause it may contain if you are bringing a personal injury claim against another for medical expenses that were paid, all or part, by a health insurance carrier. If you do not have a personal injury attorney, call Simmons and Fletcher, P.C. for a free consultation: 800-298-0111.
Paul Cannon has practiced personal injury trial law since 1995. He is Board Certified in Personal Injury Trial Law (2005). He has earned recognition as a Super Lawyer by Thompson Reuters in 2017 & 2018, and as a Top 100 Trial Lawyer by the National Trial Lawyers Association in 2017. He is a Shareholder, trial lawyer and online marketing manager at Simmons and Fletcher, P.C. His legal writings have been published by the Texas Bar Journal, Business.com, Lawyer.com HG Legal Resources, Lawfirms.com, and others. He has been asked to give education talks and media interviews on dog bite law.