Subrogation is a legal term that is not used very often, except in personal injury claims. Subrogation refers to a party assuming the rights of another party.
In personal injury cases, subrogation often refers to reimbursement for medical bills. Your health insurance company is paid back for bills it paid related to your personal injury. Subrogation claims prevent injured parties from recovering twice for the same damage or loss.
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How Do Subrogation Claims Begin in a Personal Injury Case?
Typically, the at-fault party compensates a victim for their injuries and damages. Medical bills, lost wages, and out-of-pocket expenses fall under the category of economic damages.
The accident victim may also receive compensation for their pain and suffering and other non-economic damages.
However, the injured party must create liability for damages. Most personal injury cases are based on negligence, which requires proving duty of care, fault, causation, and damages.
The insurance company for the at-fault party typically pays the claim for an accident or other injury. However, until the case settles, the injured party is responsible for paying their medical bills and other expenses.
As a result, most people turn their medical bills over to their health insurance companies.
The health insurance company may pay the bills or some of the bills related to a personal injury. However, the health insurance company tracks each payment related to the personal injury claim. They flag your account as having a potential claim against another party for damages.
Your health insurance company notifies you of its subrogation rights. In most cases, your health insurance contract has a subrogation clause within the document.
Typically, the subrogation clause gives the health insurance company the right to pursue a claim against the party who caused your injury, even if you decide not to pursue a claim. Therefore, if you do not cooperate with the claim, your conduct could be considered a breach of contract.
If so, you could lose your insurance coverage and may owe the insurance company money for any medical bills it paid related to the injury.
How Do Subrogation Claims Work in Personal injury Cases?
Typically, subrogation claims are paid from personal injury settlements. You cannot recover money for medical bills you did not pay. The compensation for medical bills paid by your health insurance company goes to the company instead of you.
Therefore, before disbursing any funds from the settlement proceeds, your Miami personal injury lawyer must verify all subrogation claims and outstanding medical liens.
These amounts must be paid from the settlement proceeds because your medical bills were included in the personal injury damages.
Experienced personal injury attorneys negotiate with health insurance companies and medical providers to lower the amount of their claims. The health insurance company is not required to accept a lower amount or waive its subrogation claim.
However, our skilled Miami personal injury lawyers diligently negotiate with the providers to keep as much money from your settlement for you.
Beware of Subrogation Waivers in Personal Injury Settlement Agreements
It is always wise to have an attorney review a settlement agreement before you sign it. Insurance companies always watch out for their best interests. Therefore, the settlement agreement might contain terms and conditions that are unfavorable to you.
One clause that many insurance companies include in a settlement agreement is a subrogation waiver. You might assume this waiver benefits you, so you agree to sign the agreement.
However, the subrogation waiver protects the insurance company and could hurt you.
The subrogation waiver protects the liability insurance company from any responsibility for additional claims. By signing the agreement, you could waive your health insurance company’s right to pursue a claim. If so, it could cause problems with your health insurance coverage.
Furthermore, the liability insurance company might use the negotiated rates from your health insurance provider and the medical providers to calculate the value of your medical bills.
These negotiated rates do not apply to individuals. If you accept the settlement, the medical providers will look to you for the difference between what they usually charge and what your health insurance company pays.
Do Subrogation Claims Apply to Government Health Insurance Plans or Assistance?
Some individuals may have health insurance coverage through the Medicare or Florida Medicaid system. Government entities and their insurance providers can file subrogation claims for personal injury cases. If so, these claims must be paid from the settlement proceeds unless the providers agree to waive their rights or accept a lower amount to settle the claim.
Schedule a Free Consultation With Our Miami Personal Injury Lawyers
Our legal team at Shaked Law Personal Injury Lawyer works to recover the maximum compensation for your injuries. We aggressively negotiate subrogation claims. Contact our law office to schedule a free consultation with one of our experienced Miami personal injury attorneys to discuss your case. Call us at (305) 937-0191.