QuestionQUESTION: Hi.
I had a car accident in 2009 in Plano,texas in which i was the passenger. I suffered a thumb fracture and had a surgery and subsequent physical therapies. I now have a permanent screw in my thumb. My medical expenses were paid by my health care insurance company.
The case was going on and the third party insurance person was in touch with me. He had asked me for a medical lien from my insurance company but i did not at that time quite understand what a "lien" was. so i contacted my medical insurance company and asked them to send me a document containing info on how much money they had spent on my case. they just asked me to look it up in my claims section in their online application. so i took printouts of the same and gave them to the third party insurance people.
Currently we (me and the third party insurance company)have come to a settlement wherein i am going to get some injury compensation (not a big amount) and a part of it is for my medical insurance provider.(this amount is equal to the amount which they had actually paid towards my case which was available in the online claim information)
Now my concern and question is since i did not technically ask my medical insurance provider for a "lien" and my insurance provider and the third party insurance company did not have a mutual interaction is it going to create any kind of issues for me ?
Also, i have asked the third party insurance provider to deal with my insurance company themselves and send them their rightful cheque. (as i dont want to get involved in anything)is that OK ?
The third party insurance provider has sent me a release letter which states i have agreed on the settlement amount and that a part of it will go to me and a part of it to my insurance provider and i will release all concerned parties whosoever from any further dealing with the third party insurance company. Before signing the release i thought it would be a good idea to know if I was doing anything wrong unknowingly.
Any useful information is greatly appreciated.
Thanks.
ANSWER: Okay, so a "lien" is different than a subrogation right. What it seems that you are dealing with is a subrogation clause. Basically, if the third party carrier knows about the potential for a subrogation claim and they still settle with you, then they can be held responsible for any monies that are due to your health insurance provider for payments already made.
What you have described seems perfectly valid to me. It seems you are doing the right thing. Many people would not even think twice about the potential for stepping on the toes of a "lien". I am not an attorney and this is not legal advice, but it seems you are fine. Your medical insurance provider does have a legal right to collect monies they have paid out on your behalf if the contract of insurance provides for it and you are considered to have been "made whole". In some circumstances, it may be improper for the third party carrier to pay your medical insurance carrier if your damages are more than the amount you have received from insurance benefits.
I am sorry this answer is a little complicated, there is just no simple way to explain these subrogation clauses and the related laws and rules. If you have specific questions or need additional direction, I suggest you call our office directly. Information is always free at Petty Details, LLC!
JP
---------- FOLLOW-UP ----------
QUESTION: Thanks for your opinion.
I have followup question.
Is it my medical insurance provider's responsibility to ask for the lien
or
is it the third party's responsiblity to ask them the lien
or is it my responsibility to ask my medical insurance provider for the lien ??
Please let me know your views
Answer1. It is not the responsibility of the third party to ask for the lien. (Medicare can be an exception)
2. Your medical insurance is responsible for invoking their own subrogation lien by sending written notice to the at fault party/carrier.
3. It is your responsibility to never knowingly collect twice for the same damages.
I hope this helps.
JP
