Subrogation is a term used in many personal injury cases. It refers to a claim against a personal injury settlement or verdict. Understanding how subrogation claims work helps you know what to expect when you settle your claim or go to trial.
What Is Subrogation?
Subrogation is a party’s right to assume another party’s legal right to a cause of action. Most health insurance policies contain a subrogation clause giving the company the right to assert these claims. This means that if your health insurance company pays for your medical bills, it can seek reimbursement from the at-fault party’s insurance if you file a personal injury claim.
How Do Subrogation Claims Work in Personal Injury Cases?
In personal injury cases, subrogation usually refers to the right of a health insurance company to pursue a claim against an at-fault party for reimbursement of medical expenses.
Personal Injury Insurance Claims
For example, suppose you were involved in a car accident caused by another driver. Your health insurance company paid your medical bills for treatment in the emergency room. The other driver’s insurance company paid to repair your vehicle, but you did not pursue an injury claim.
Your health insurance company could assert its subrogation claim to pursue a claim against the at-fault driver. It would allege that the driver is responsible for paying your medical bills because they caused the accident. If there is proof of fault, your health insurance company could recover what it paid for your medical care related to the car accident.
Personal Injury Lawsuits
On the other hand, let’s assume you filed a personal injury claim seeking compensation for your economic and non-economic damages. Economic damages are your financial losses, including loss of income, medical bills, and out-of-pocket expenses. Pain and suffering, emotional distress, impairments, and diminished quality of life are included in non-economic damages.
Your health insurance company notifies you that it is exercising its subrogation rights. Therefore, you must reimburse the health insurance company for the medical bills it paid from a personal injury settlement or jury verdict. Even if the company does not demand repayment, you have a duty to confirm whether the company is claiming the right.
Generally, experienced personal injury lawyers contact the health insurance company to confirm claims. The attorney is required to pay outstanding medical bills and subrogation claims before releasing any funds to the injured party.
Can You Negotiate a Subrogation Claim for a Nevada Personal Injury Claim?
Insurance companies are not required to negotiate a payoff. However, the funds received for a personal injury claim may not be sufficient to pay all damages. Therefore, experienced injury lawyers usually attempt to negotiate lower payoffs for subrogation claims to increase the amount their client receives for a personal injury settlement.
Whether an insurance provider agrees to lower the amount of a subrogation claim depends on many factors. An attorney may make a compelling argument that the victim’s pain and suffering are substantial, and the attorney pursued all sources of compensation for the claim. The company may agree to reduce the payoff to allow the victim more compensation for their pain and suffering.
Subrogation Claims Apply to Most Types of Health Insurance Coverage
Most private health insurance companies include subrogation clauses in their health insurance policies. State law governs subrogation claims for most of these policies. However, federal law governs subrogation claims if you have an ERISA health insurance plan through your employer. Give your attorney a copy of your health insurance documents as soon as possible for review.
Insurance provided by Nevada Medicaid, Medicare, and the Nevada State Children’s Health Insurance Programs may also have subrogation claims. Notify your attorney if you receive benefits for medical care from any government programs.
What Happens if I Refuse to Pay a Subrogation Claim in a Personal Injury Case?
A subrogation claim is a medical lien on personal injury proceeds. It is a legal claim.
Failing to pay subrogation claims can result in legal action. Generally, if you do not pay subrogation claims for government insurance providers, your eligibility to receive future benefits could be jeopardized.
The company may sue you if you do not pay a subrogation claim for a private health insurance company. The lawsuit could result in a judgment for the amount you owe for the subrogation claim plus interest and attorneys’ fees.
How Should I Handle Medical Bills After an Accident or Personal Injury?
Receiving prompt medical treatment is essential after an injury or accident. Medical records help prove you sustained injuries and the severity of your injuries. However, paying for medical treatment can be challenging.
Your insurance company may cover most of the cost if you have health insurance. If not, talk to your personal injury lawyer. There could be other options for handling medical bills, including medical liens and agreements with your medical providers.
Learn More About Subrogation During a Free Consultation with a Las Vegas Personal Injury Lawyer
At De Castroverde Accident & Injury Lawyers, our Las Vegas personal injury lawyers work to obtain the maximum amount available for your injury claim. Call our office for a free case evaluation at (702) 222-9999 to discuss how much your case is worth.
