Subrogation occurs when a party assumes the legal rights of another party. For example, the right to recover money for medical bills after a car accident or other personal injury. 

Health insurance companies file subrogation claims against personal injury settlements and verdicts. The claim is to recover the medical bills they paid related to the accident. In other words, you may need to pay back your health insurance company after an accident. 

How Do Subrogation Claims Work in a Personal Injury Case?

How Do Subrogation Claims Work in a Personal Injury Case?

After a personal injury, the victim incurs doctors’ bills and other medical bills to treat injuries. The party who caused the injury may be held liable for paying those medical bills. However, the injured victim does not receive any money for their damages until the case is settled or resolved at trial.

Therefore, the injured person is responsible for paying the medical bills as they incur them. Suppose the person has health insurance. If so, they may file the medical bills with their health insurance provider. 

Most health insurance policies cover medical bills incurred because of an accident or injury. The health insurance company pays the medical bills, according to the health insurance policy terms. 

Let’s say that the insurance company notes that the injuries were caused because of an accident or other incident. It notes that your injury could potentially be the cause of a personal injury claim. Your health insurance provider notifies you of its right of subrogation. In other words, it intends to file a subrogation claim to recover money from your personal injury settlement. 

In most cases, the terms of a health insurance policy require you to cooperate with any subrogation attempts. Therefore, you might not pursue other damages for a personal injury claim. You must cooperate with your health insurance provider if it files a subrogation claim against the person responsible for causing your injury.

What Happens After I Settle My Personal Injury Case?

Subrogation prevents a person from receiving double compensation for damages. 

For example, your health insurance company pays your medical bills. The at-fault party pays you for those bills. You would profit from your injuries if you were not required to reimburse the health insurance company for the costs. 

Your personal injury lawyer verifies outstanding medical bills and subrogation claims. Those amounts are paid directly to the medical provider or the health insurance company. The payments must be made before you receive any money for your damages.

The insurance company is not required to accept an amount less than it paid for your medical bills to satisfy a subrogation claim. A skilled Houston accident attorney will attempt to negotiate a lower amount based on the facts of the case. 

For example, an at-fault driver’s insurance coverage was insufficient to pay all damages. Therefore, paying the subrogation claim in full would leave you with very little money to compensate you for other economic and non-economic damages. 

Do State Assistance Benefits Have Subrogation Rights?

Medicaid and Medicare benefits are also subject to subrogation claims. The government agency or a government health insurance provider can file a subrogation claim. Those claims must be paid from any funds you receive from the at-fault party. 

Failing to reimburse a government health benefit after a car accident or other injury could cause problems with future coverage. If you have Medicaid, Medicare, or any government health benefit, it is best to consult an accident attorney before settling any personal injury claim. 

Be Cautious of Subrogation Waivers in Settlement Agreements and Other Insurance Company Tactics

It is best to have a personal injury attorney review a settlement offer from the at-fault party. The insurance company might include a subrogation claim waiver in the settlement agreement. The waiver protects the company from further claims. However, that clause could negatively impact your health insurance coverage.

Insurance companies always have their best interests in mind when settling personal injury claims. Therefore, they will always try to lower the amount they pay to settle a claim. That may include inserting a clause to waive subrogation claims. It could also include using the reduced health insurance rate for medical bills. 

You could be liable for thousands of dollars in unpaid medical bills if you do not have legal counsel. The settlement agreement releases all claims you have regarding the accident. Therefore, you give up your right to demand more money or file a lawsuit. That is the case even if you discover additional damages or injuries. 

A personal injury lawyer can help you document all damages to calculate a fair and reasonable settlement amount. 

Contact Us to Schedule a Free Consultation With Our Houston Personal Injury Lawyers

Our law firm has extensive experience handling subrogation claims. We work to reduce the claims to put as much money from a personal injury settlement in your pocket as possible. Call our law office to schedule your free consultation with an experienced personal injury attorney in Houston, TX.