Legal/Insurance terms - Subrogation Claim?

While you may not need an attorney, you shouldn’t discount the possibility. There’s a good chance that you have some avenue of recovery you didn’t know about; a personal injury attorney would earn only a portion of that recovery, and will almost certainly handle the subrogation issue free of charge. Remember, an initial consultation will be free no matter what.

Hey, Inigo’s an adjuster? Who knew??

That’s a really good point that I didn’t think of. If you’ve already received a bodily injury settlement from the responsible party’s insurance company (and if you signed paperwork signing away the right to pursue future related BI claims, which a lot of people do although they shouldn’t), then you’re liable for the bill yourself.

Actually, as I wasn’t conscious at the time, I wasn’t making any medical claims at any time for this whole process. If the people at the hospital can’t be expected to figure out where to send the bills for an obvious car accident, then I don’t think it’s quite fair to blame a lay-person (who wasn’t THERE at the time, mentally speaking) for failing to know every detail about who covered what.

And yes, I am insured, by car insurance and health insurance. I *do *think that I should be covered for the things they say that they cover - no magical thinking about it.

Also not magical thinking to be of the opinion that if someone else caused the accident, was held at fault, and had to pay out an insurance settlement for that, they should have to pay for the damages they caused. Simply because some idiot in a doctor’s office billed the wrong company in the process, I should not have to pay that myself just because it took 9 months to get the info sorted out.

Sorry to bring it up. But in light of the silliness which constitutes 95% of my other posts here it seems prudent to make it clear when the clown makeup has come off. Now give me back my nose and bicycle horn. I’m outta here.

Unless it was hidden really well in the legalese (which I’m not discounting) I’m pretty sure I specifically did NOT sign anything like that. The doctor’s bills hadn’t come in at the time they wanted to handle the initial settlement amount, so I was worried about all that not getting covered if I signed.

Now, I may have been misled and signed anyway, which I will be unhappy about, but I did *attempt *to not do that.

A lot of your rights now depend on the wording of your release (assuming you waived payment of medical bills as part of the settlement). In some states, you can’t waive payment of medical bills which you have already incurred at the time of the settlement, because of exactly this problem (ie., finding out six months or more after the fact that the medical provider didn’t bill correctly).

In some states, you can, and then you’re SOL.

This sentiment is absolutely justified. It is also wrong. Let me asplain…No, is too much, let me sum up. You got broken, someone patched you up. You received services, someone wants to be paid for them. No matter how many wallets are involved, YOU ultimately are responsible for making sure the right people get paid.

And that’s a pain in the ass. Because all anyone ever tells us about insurance is that you pay your premium and you get coverage. Some people catch on that “coverage” is a really vague term and tweak their insurance to match their own risk management philosophy, but most people don’t. And almost nobody understands concepts like subrogation, even though they make perfect sense when you think about them, because almost nobody thinks about them.

Like so many things, you don’t realize how much you don’t know because you never know how much there is to know about something you haven’t had the occasion to learn about.

I missed the part about the release. If the release is valid you may not
be entitled to anything more from the responsible party.

I urge you to get all your papers together now, and take them to a lawyer
without further delay. It sounds like you were entitled to much more than
what you got and there may be a way out of the release if a release is actually
what you signed, if you were unaware of your rights and someone took unfair
advantage of you.

Also call the insurance commissioner’s office re the subrogation matter,
and if I were you I would so today.

I would be too, anyone would.

This is based on…what, exactly? So far it only sounds like the only thing that was owed and not given was a clear explanation along the lines of, “This is your settlement, it includes X, Y & Z–when you sign this, there’s no more money, you’re on your own, don’t come crying to me.”

And in any event, that understanding is legally implied with the signature on the document that says as much, no matter how cryptic the legalese is.

(1) On the basis of tha fact that OP has indicated he has paid for some
of his medical expenses out of his own pocket. There is no jurisdiction
in the country where he should have to pay anything if his expenses
were incurred solely as the result of another’s negligence. I believe obligation
rests with the liable party or his representative to make this clear, and
merely shoving a release at him and saying “sign this if you want to get
paid anything” is probably outright fraud.

(2) On the basis of the fact that when I was an adjuster injury settlements
were definitely negotiable, and almost always ended up including consideration
for pain and suffering over and above the actual expenses. Rule of thumb was
that any injury claim was worth settling for three times actual medical expsenses
in the case of minor injury and possibly much more in the case of severe injury.
Now, the liable party is almost surely not obligated to divulge all that. However,
I think our OP needs to be aware of it, if you do not object too strenuously.

OK, try this on for size.

You are hurt in an auto accident. You incur $10,000 in medical bills which you submit to your health insurance company. You pay your $1000 deductible, the health insurer pays the remaining $9000.

Six months later you reach a settlement with the other driver’s auto insurance company. Say it’s for $30,000. That $30,000 is for several different things – pain and suffering, time off work, permanent injuries and medical bills. So the settlement might be $10,000 for pain and suffering, $10,000 for time off work and $10,000 for medical bills.

But you didn’t pay $10,000 worth of medical bills. You only paid $1000 of medical bills and your health insurance company paid the other $9000. Your health insurance company wants its $9000 back.

I got that part. Inigo esplained… scuse me, summed up quite well actually. :smiley:

What I’m a little upset about now is that I’m pretty sure (as certain as can be 9 months after the fact…) that I DID NOT get a final settlement from the car insurance people that said they weren’t going to take care of my medical bills, because NONE of the medical stuff had been billed by that time, and I sure as snot didn’t get enough of a settlement to cover ANY of that.

Now, that summed up, there are really only two options, both of which require me to get home and sort through my paperwork and then make some calls.

Inigo, a moment more of your time would be lovely here to validate/respond to the below statements:

On the one hand, if I DID NOT sign a Bodily Injury Settlement, then the health insurance needs to take it up with At-Fault-Dude’s car insurance. Yes?

I can get them that info easy peasy, but it’s still a little nasty of them to send me a bill first, hoping I’d be dumb enough to pay it out of hand.

On the other hand, if I DID sign a Bodily Injury Settlement (under blatantly false pretenses from the car insurance people notwithstanding), I am now responsible for the health insurance’s payments. Yes?

OK fine. I get that the health people need paying. HOWEVER, if that’s the case, I’m going to be really upset with the car insurance people, and finding out what I can legally do about that. Not so easy-peasy.

If the second option pertains, are there processes for me to tell the health insurance to back off a while until a decision is reached? Or should I bite the bullet, pay them, and then hope to reclaim my money at a future time from the car insurance people?
Also, for everyone helping me and giving info - I greatly appreciate it. This has been much more enlightening than my searches were. In fact, I’m tempted to take Inigo’s first response and paste it over the current wiki article. His version makes a lot more sense.

Gawd help us all.


Seems nasty, but it’s all part of full disclosure. They’re letting you know they want their money. Whether you pay it out of your own pocket or direct them to a particular claim number is of no consequence to them.


If by “second option” you mean you’ve not yet settled the claim, then yes–direct them to the other dude’s insurance claim #.

Although you could probably do this, I would not. With copays and health insurance deductibles you’re going to incur out of pocket expenses in a claim like this. You are owed reimbursement of all those. There really isn’t any point in taking on more when all you have to do is tell the health insurer to get in line.

colonial, I didn’t mean to piss you off. You are absolutely right that, when all is said and done, the OP should not be sitting on unreimbursed expenses. I was just pointing out that, in the event there was a settlement, we don’t know how much it was for, or what the expenses were. Could have been a $40k settlement with $10k in meds–which would be extraordinarily generous in most cases. As for

Bit of a hijack, but that depends entirely on the litigation venue. I know Louisiana and Most of New Mexico are pretty generous with pain and suffering. Colorado, on the other hand is not. And in any event, if a case goes to court the defense will always remind the jury to pay for the injury, not the treatment. Consider that a MRI of your neck might cost $950 in one office while another provider, just across the street, might ask $5,000. The results and processes are the same: hold still in this tube for 20 minutes. Is the correct compensation for enduring the procedure $4,000? Or even $20,000?

Originally Posted by **Lasciel **

Originally Posted by** Inigo**

Actually, I meant the other way around. If I *did sign *the agreement, and DO owe them the money myself, can I ask them to please hold off for a sec while I figure out if I can sue the pants off the car insurance people for lying to me to get me to sign their settlement? (minus the exaggerations and colloquialisms, of course.)

Oh, I see. That’s a pair of pretty tall orders there, pardner. Sounds like you taped some conversations, which might be useful if you’re accusing someone of misleading you, but what you’ll need to do is convince someone that you signed something that says you read and understood the terms of, received and cashed a check as a result, and that they should now void that contract because its existence is no longer convenient for you. You see why this might be a problem. But I’m no lawyer. Fight that fight if you feel you should.

:smiley: Didn’t say it was an *easy *idea. However, I’m still under the impression that I never signed anything like that at all, so hopefully I’ll be able to pop into this thread tomorrow and tell y’all that the car insurance company is now paying that particular med bill like they were supposed to in the first place. :slight_smile:

Again, thank you all very much for the information. I think on the one hand, I’m glad I’m more enlightened, on the other, I’m a little peeved that there isn’t anything I can conveniently do to “tweak my insurance to fit better,” because it’s mandated and specified by my place of employment.

I am 100% sure that in 1970s North Carolina health insurers had no right
of subrogation against a policy holder for medical expenses incurred due
to another’s negligence, even if the policy holder was paid the full $30k by
the responsible party or his insurer.

Furthermore, if a health insurer had had a right of subrogation against a
responsible party for medical expenses it occurs to me that would have been
a factor in all the settlement negotiations I took part in, since I always
represented the responsible party’s insurance company. Therefore I will say
I am 100% certain no such right exisited either in the 1970s.

Fine, dude, you let this Imago guy take you all the way through here, and forget
about lawyers and insurance departments who are in a position to give you truly
professional advice.

Hey, someone might think you were gaming the system, including your employer,
and it would be better to eat a few bills than let that happen, wouldn’t it?

:dubious: Who said anything about not consulting DOI or an attorney? Certainly nobody with experience in this field more recent than 32 years. Those are both valuable resources, and should someone from either field chime in I’m sure the OP would welcome their perspective as well. Sorry if I’m coming off as a douchey know-it-all, but this is GQ and I’m pretty fairly well-versed, and current, in this very narrow topic and can speak with some professional authority.

I have repeatedly identified the state I worked in for these reasons.
However, I would be suprised if there was a venue in the country where
insurers that would not prefer to settle for at least 2x expenses, rather
than risk the expense and uncertinly of a jury trial in a case where liability
was clear.

Correct compensation is medical and other expense actually incurred
by the plaintiff. I think we called medical expenses “special damages”
or “specials” 35 years ago. Of course the jury may see fit to tack on
an amount for pain and suffering much greater than actual expenses.
To what extent court will allow defence to suggest plaintiff has padded
his case I do not know, and that may also depend on venue.