QuestionHi, Bennie:
I read to know you have been answering the questions related to auto accident claim to many questioners and they were very helpful and contain huge amounts of information. I am just wondering if you could help us with very similar questions related to our auto accident that occurred on Jan. 16, 2006. On that day, I drove on the speed lane of a 3 lane high way following a SUV (no tailgate) in front of my car. I noticed the SUV SUDDENLY changed to center lane without any signal. After that I saw a long A shape ladder laying across from lane I was in. I have to make a sudden move to the center lane too. Unfortunately, it was too late .The car hit the ladder on the front corner on the driver's side. My car was slightly out of control sliding to the outer lane and back to the center lane. At this time, a another SUV hit my car on the rear corner of the driver's side. We didn't find the owner of the ladder and neither me or the SUV driver who hit me got a cite. But my insurance company decided to settle this case with my wife. My wife suffered a bone fracture and stayed for 3 days in the hospital. My medical insurance company paid all the expenses for the treatment (the Hospital billed them about $15,000.00, but the insurance company only paid them about $7000.00). My wife got a settlement of close to $35,000.00 from my car insurance company (I had 25,000/50,000). Almost two years has passed since the accident. Recently I received a letter from a law firm in Tennessee (I am in Ohio) stating that they are trying to seek reimbursement of the medical payment for my health insurance company and the attorney told me that they are willing to negotiate the amount I am willing to pay, such as half of the amounts they paid to the hopital (about $3000.00). I haven't agree with that yet. They are still waiting for my offer. I understand that they have the right to seek reimbursement in this case. But Doesn't this reimbursement depend on the several conditions including the "made whole" in the claim? In our case, my wife has not been "made whole" in the claim. She should have gotten at least 3x %15000.00=$45,000.00 for the claim and she is feeing the pains in the wounding area right now. We maybe willing to make $500.00 payment to avoid the further trouble in the future, but not sure they will accepted. My question is what do you suggest me to do? If we refuse to pay the amount they want, are they going to file a suit against me or my wife for $3000 or full $7000.00? How much do you think I can make offer to them if I have to pay them back?
Thank you for your help.
Joey
AnswerHi Joey,
In order to properly answer your question, I am going to have to kind of walk through the entire accident and claims process.
First, even though it was unavoidable, you hit an object lying on the roadway. To the insurance company, this is a collision and you were at fault. This is the reason that your wife received an injury payment from your own insurance company. She was an innocent passenger. If you, as the fault driver had been injured, you would not have been paid any injury compensation.
Many health insurance companies contain a clause that requires they be reimbursed if the claimant recovers from a 3rd party. Your auto insurance that paid your wife is considered a 3rd party.
Your health insurance is not a part of the auto insurance philosophy of the right to be made whole.
If your health insurance had been on top of the issue, they would have filed a lien with your insurance company against your wife's settlement and would have been paid the full $7,000 and your wife would have received the balance of the settlement, or about $28,000.
Your health insurance is now trying to reach a compromised settlement with you for a reduced portion of the amount that they paid out instead of filing a lawsuit against your wife for the full $7,000.
If you don't arrange a compromise settlement, they have the right to file a lawsuit for the full $7,000 plus their attorney fees. If your health insurance policy stipulates their right of recovery, they will surely win the case in court.
The fact that they are willing to accept a reduced amount is very unusual. They normally want the full amount. You might be able to negotiate them down to $2,000 - $2,500 but I doubt that they would consider anything lower.
Before talking to the health insurance attorney, you may wish to hire an attorney to read your health insurance policy and the letter from the attorney in Tennessee and advise you as to your future actions. Most attorneys will charge between $250 - $300 per hour for this service.
I hope that you have found this information to be of help.
Your feedback by rating my answer will be appreciated.
Sincerely,
Bennie
San Francisco Bay Area
