QuestionQUESTION: Hi Jane.
I was in an auto accident early last year, in which the other party was at fault. After several months of medical treatment, it finally culminated in back surgery.
I am in Florida, and my PIP was exhausted very quickly. My personal health insurance covered many expenses, (less co-pays and deductibles), but I have not seen any subrogation claim from them. My employer has since switched health insurance carriers, so I am no longer even with that carrier.
I am starting to prepare a claim for the at-fault's party's car insurance. My question is: If I have not received a subrogation claim (or notice), am I required to still reimburse my previous health care insurance provider for the payments they made?
If so, I estimate my total claim to be worth about $400-$500K, but the insured's policy limits are only $200K. Assuming I were to recover the policy limits, would that make a difference in how much I should reimburse?
I hope this made sense to you, and thank you in advance.
ANSWER: Pam ...
To answer your initial questions, yes, the benefits paid to you previously will likely be offset from your eventual settlement.
Theoretically, unless the at fault carrier is willing to settle with you for the FULL policy limits (are you sure those are the ONLY policy limits available!!) you need professional legal advice.
And what about Uninsured Motorist? Do you have that? I certainly hope so.
Here's my advice. This claim is complicated. There could be additional coverage available - for example an umbrella, or some other source. Only an attorney could determine that for you. And there is no guarantee the at fault carrier will settle for the full limits. Things are not always as cut and dried as they seem. For example, did you have a prior history with back pain? They might try to use something like that to avoid a full policy settlement.
I can only give you one piece of advice. I hope you will take that advice.
You obviously have serious, long term, permanent injuries. In order for you to receive the maximum settlement owed to you, you should retain a qualified Personal Injury attorney. Now.
---------- FOLLOW-UP ----------
QUESTION: Thank you for your answer, Jane. I'm trying to avoid having to pay out 1/3 of my potential settlement to an attorney, if at all possible. Especially if I have to pay back my previous health insurance carrier also.
After both of these, there will be not much left for me, and I still have 2 herniated disks that the doctor says are "not bad enough to warrant surgery" at this time, but will probably become problems down the road.
How do I find out about the possible existance of an umbrella policy? Is the insurance company required to tell me if I ask?
To answer your questions to me:
Yes, I have uninsured/underinsured coverage for $50K. It's my understanding that I have to receive full policy limits from the insured to even ask for this, though.
I have no history of back problems, in fact, just the opposite. I had been working with a personal trainer for a few months prior to the accident with no problems at all. I actually had an appointment for that evening that I obviously had to cancel. I was training for the Fight for Air Climb of the Bank of America Building in Jacksonville. (Couldn't do that, either).
Fault is also not an issue, as a police officer witnessed the guy plow into me as I was already stopped in traffic. The officer said the guy never even used his brakes, and gave him a ticket for reckless driving.
The guy's insurance company paid to repair my car immediately, and even arranged for a rental car while mine was being fixed.
I've recently been told by my orthopedic surgeon that now it's just a matter of trying to get my life back; that until the disks need attention, there's really nothing else he can do for me.
So how do I go about figuring out how much I will have to pay back to my health insurance?
Thanks again. You've been a great help so far!
Answer Hello Pam,
I'm glad to have been of help. But like I said before, your claim is complicated. While I thoroughly understand your reluctance to pay an attorney 30%, the flip side is that without an attorney most people in my opinion are victims of lowball settlements.
From what you are saying, I believe that you are entitled to the FULL POLICY LIMITS for both the liability BI coverage from the other side and for your UM benefits.
As for UM, you would have to show two things. First, that you have zero liability and, second, that the 200K was inadequate (i.e. underinsured) to cover your loss.
The problem is, many insurance companies will resist full settlements on UM claims.
If you can accomplish the following, settle without an attorney:
Write the liability carrier and ask them to provide you with all coverage limits available from the at fault driver. There is a danger here, however. If there is an umbrella policy for example, it may not be disclosed. But you should certainly ask.
Demand and receive payment of the full policy BI limits. You have not only your medical bills, but also years of future pain and suffering. Important: Only an attorney can legitimately calculate pain and suffering.
Demand and receive full payment for your UM claim. This is probably not going to happen. Though in my opinion, based on the facts presented, you are entitled to it.
If you cannot accomplish even one of these objectives - you need an attorney. Understand that more often than not, those who negotiate their own complicated settlements actually receive less than if they had retained a competent personal injury attorney and paid the 30% fees.
As for your other medical benefits, your settlements should include "offsets" for those payments, meaning that they will be deducted from your sum as payment to the other carriers.
Again, this is something that is best negotiated by an attorney.
In short, I am very leery of your being able to negotiate what you deserve on your own. If you can do it - fantastic!! But I have my doubts. Insurance companies generally have different approaches when dealing with a claimant alone vs that claimant having a skilled attorney.
Good luck!
Jane
