Why do I have to pay my health insurance a portion out of my Personal Injury settlement?

Why do I have to pay my health insurance a portion out of my Personal Injury settlement?

When individuals are involved in a Personal Injury claim, they often assume that the liability carrier, which is the insurance company for the at-fault driver, is the responsible for paying for their medical treatment directly. Unfortunately, that is not how it works. You are responsible for paying for your own medical care up front before your case is settled. If you have health insurance, you use your insurance of course rather than pay out-of-pocket, as that is far more affordable.

When you are involved in a Personal Injury claim and your health insurance pays for any of your related medical treatment, you could be required to pay them back a portion out of your settlement. This reimbursement is called “lien or “subrogation” interest. Whether a lien or subrogation is applicable in your Personal Injury claim depends on the type of health insurance plan you have and whether it is a fully self-funded ERISA plan. Determining whether your insurance plan is a self-funded ERISA plan can be very complex and is best handled by an attorney. There are also a few other types of insurance coverages which would require repayment from your settlement such as Medicare, Medicare Advantage plans, Medicare Supplements, and Medicaid. If you do not address these possible liens or subrogation interests during settlement, you could very well end up owing money to one of these entities that covered your medical bills. We strongly recommended consulting a Personal Injury attorney about these daunting questions and possible repayments from your settlement.

A common question we receive from our clients is whether it is best to refrain from using health insurance for treatment in their Personal Injury claims. In general, the answer is no…we typically recommend using your insurance so that bills are not mounting that you owe during your case. Typically, you will be better off to pay off medical bills using insurance rather than to owe the higher rate a medical provider will charge you when you are not paying with insurance. It’s important to note that there are medical providers that will avoid using your insurance in the hopes of getting paid more by you directly out of settlement, so you may have to push your medical provider to use your health insurance.

Personal Injury claims in North Carolina can be very intimidating when deciphering who is due payment or repayment from your settlement. If you were involved in a Personal Injury claim, we would encourage you to contact us to schedule a free consultation with Attorney/Owner, Maggie Shankle. At Shankle Law Firm, we can help educate you on the medical billing component, as well as other components surrounding your injury and treatment.

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