Located in the fine print of most health insurance contracts is something called a subrogation clause. The subrogation clause, which is buried in your health insurance contract, states that if an insured party makes a recovery in a personal injury case, he or she is required to reimburse the insurance company.
Here's an example:
Let's say you were injured in a car accident in Fort Worth by another driver. The accident wasn't your fault and you had to go to the hospital. You pay for your medical treatment with your health insurance. Later, you decide to file a personal injury claim against the insurance company of the negligent driver that caused your accident. Through that settlement, you are able to recoup damages for your medical treatment, lost wages and pain and suffering. But then, you get a letter from a company such as Ingenix. What does that mean?
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- How are settlement proceeds split up?
- Why should I use my health insurance to pay for my medical expenses if the accident was not my fault?
How Subgrogation Works
Most of the time, health insurance companies hire outside companies (Igenix, Optum, Rawlings and Phia) to collect money on subrogation claims. The letter you received from Ingenix is the subrogation letter and because of that clause in your health insurance contract, your insurance company wants you to reimburse them for the medical treatment they paid for after the accident.
While all contracts are different, generally when you receive a call or a letter from these companies, it means that you do have to pay the health insurance company back for the money they paid on your behalf due to the accident.
What You Owe
How much you have to pay them back depends on a lot of things, including the interpretation of the "fine print" contained in the insurance contract. These subrogation claims can become, and often are, huge hurdles in getting a personal injury claim resolved.
However, you shouldn't let subrogation claims keep you from filing a personal injury claim if you have been injured because of someone else's negligence. Hiring a good lawyer is the most important step in your personal injury case, especially if you think you might receive a subrogation letter from your insurance provider.
Protect Your Legal Rights
The personal injury and accident attorneys at the Anderson Law Firm can help you decipher the fine print in your health insurance contract. We are skilled and experienced in negotiating the right amount for your settlement, so that even if you do have to reimburse your insurance company, you are still fairly compensated for your injuries.
Contact us today for a free, no obligation consultation regarding your situation. Call us toll free at 800-354-6275 or locally in Fort Worth, TX at 817-294-1900.