Legal/Insurance terms - Subrogation Claim?

[colonial]

@Inigo_Montoya

:dubious: Who said anything about not consulting DOI or an attorney?

You did not mention them in seven earlier posts even though OP admitted
to igniorance and confusion right off the bat. In fact, no one recommended
DOI or an attorney except for me.

@Inigo_Montoya

…I’m pretty fairly well-versed, and current, in this very narrow topic and can speak with some professional authority…

You have not shown it.

[Inigo_Montoya]

@colonial

You have not shown it.

Ah, so you are seeing incorrect, unfounded or misleading information from me? I invite your critiques. Were your own assertions about settlement values or the subrogability of medical specials anything like temporally relevant I would gladly engage in a little back and forth inasmuch as such would be related to the OP. But we can do this one-way if you like. Or perhaps you have a separate thread in mind?

[Rachellelogram]

honk honk!

@colonial

I will say
I am 100% certain no such right exisited either in the 1970s.

I am 100% sure that the 1970s were like 40 years ago, dude. Seriously, so much of insurance law has changed. You do not know what you are talking about. Inigo’s information has been the best, most up-to-date, and most relevant in the entire thread. The 3-4x rule for pain and suffering is not followed anymore–that is an outdated methodology. Back then, people were pretty much “guaranteed” an amount of pain and suffering if they so much as visited a chiropractor once for neck pain. These days adjusters don’t tend to offer P&S, it’s pretty much just your bills. Unless you are losing major time from work, or lost a finger, or can’t breastfeed, or something seriously impacting your life.

I have a clerical position in the claims department (and see many adjuster’s notes on a daily basis). I’m not even an adjuster, and I know your advice is totally outdated.

[colonial]

@Inigo_Montoya

Ah, so you are seeing incorrect, unfounded or misleading information from me?

Yes.

@Inigo_Montoya

I invite your critiques.

For starters see our posts #29-30. How’s your attention span these days?

@Inigo_Montoya

Were your own assertions about settlement values or the subrogability of medical specials anything like temporally relevant

“Temporally”? BI settlement and medical special subrogation have been
core issues of this thread from OP. That makes anything anyone says about
them relevant.

@Inigo_Montoya

I would gladly engage in a little back and forth inasmuch as such would be related to the OP. But we can do this one-way if you like. Or perhaps you have a separate thread in mind?

Suit yourself, and I’ll keep in touch.

[Really_Not_All_That_Bright]

I think we can settle this tiff fairly easily. Lasciel, are you in North Carolina, and did you accident occur in the 1970s?

Incidentally, where are you? It makes a big difference, particularly with regard to fault.

[colonial]

@rachelellogram

honk honk!

I am 100% sure that the 1970s were like 40 years ago, dude. Seriously, so much of insurance law has changed. You do not know what you are talking about. Inigo’s information has been the best, most up-to-date, and most relevant in the entire thread. The 3-4x rule for pain and suffering is not followed anymore–that is an outdated methodology. Back then, people were pretty much “guaranteed” an amount of pain and suffering if they so much as visited a chiropractor once for neck pain. These days adjusters don’t tend to offer P&S, it’s pretty much just your bills. Unless you are losing major time from work, or lost a finger, or can’t breastfeed, or something seriously impacting your life.

I have a clerical position in the claims department (and see many adjuster’s notes on a daily basis). I’m not even an adjuster, and I know your advice is totally outdated.

A good adjuster may start with a specials-only offer, but I would be willing
to bet the vast national majority of all BI claims, even small ones, settle
for more than specials and that probably includes your location.

As for Mr. Inigo’s take on that subject you seem to have missed this, so let
me highlight in in bold for you this time, with the key phrase underlined as well:

(from post #29, emphasis added)

@Inigo Montoya

I know Louisiana and Most of New Mexico are pretty generous with pain and suffering.

Subrogation law may or may not have changed regarding insurers’ rights
vis a vis their insureds. That I intend to look into a bit myself since no one
here impresses me as enough of an authrority, including you and Inigo
for damn sure.

[Inigo_Montoya]

@colonial

Yes.

What.

@colonial

For starters see our posts #29-30. How’s your attention span these days?

You said the OP was entitled to much more than was awarded. I asked how you knew that. You explained, in essence, that the OP should not be out any money when all is said and done and that settlements were (and they still are, by the way) negotiable. Yet you failed to point out anything the OP said that indicates the settlement was less than the expenses, or that any pain and suffering in the settlement were inappropriate for the injuries as explained by the OP. Telling someone they were entitled to more than they got, without knowing how much they got or were owed is irresponsible and, were you qualified to make such an observation, unprofessional.

@colonial

“Temporally”?

yeah, refers to proximity between two points in time. I was insinuating your experience as a BI adjustor is irrelevant given the amount of time you have been out of the game.

@colonial

BI settlement and medical special subrogation have been core issues of this thread from OP. That makes anything anyone says about
them relevant.

Only subrogation, OP didn’t mention calculation of a settlement or really express any curiosity about the subject. And as far as that goes, it only makes accurate things said about subrogation relevant. “Any Wildassed Guess Goes” and “How we did stuff back in the day…” is for IMHO, not GQ.

[Lasciel]

@Really_Not_All_That_Bright

I think we can settle this tiff fairly easily. Lasciel, are you in North Carolina, and did you accident occur in the 1970s?

Incidentally, where are you? It makes a big difference, particularly with regard to fault.

I’m in South Carolina, actually, but don’t let any of my facts stand in the way of these interesting developments, please. I was about to go pop some popcorn and watch the show!

(For other facts, I’m really only interested in the settlement itself insofar as I have to find my paperwork that lets me know what I actually got, and what it was intended to be. Although, for future reference, if that whole “lump sum and you take care of your own bills” thing is standard, I seriously needed to know that 9 months ago, and I totally would have haggled for more benjamins.)

[Really_Not_All_That_Bright]

Either way, all is not lost. There are ways out of unrepresented personal injury settlements, although that would be something to take up with a qualified attorney in your state. I strongly suggest that you do at least consult with an attorney since your own insurer is also the at-fault party’s insurer.

[colonial]

@Inigo Montoya

What.

For the 2nd time: see our posts #29-30. I am not going to repeat it again.

@Inigo Montoya

You said the OP was entitled to much more than was awarded. I asked how you knew that. You explained, in essence, that the OP should not be out any money when all is said and done and that settlements were (and they still are, by the way) negotiable.

OK so far.

@Inigo Montoya

Yet you failed to point out anything the OP said that indicates the settlement was less than the expenses,

Not OK. I assumed that you read and understood at least the OP, which states
(3rd paragraph, 2nd sentence):

@lasciel

About 9 months ago, I was in a car accident (I was not at fault) and required some medical treatment. I paid a shitload of it myself for my deductible…”

Ya gottit now?

As you know most (all?) health insurance policies include considerable
deductibles and copayments, so use of the word “shitload” is likely to
be appropriate.

@Inigo Montoya

or that any pain and suffering in the settlement were inappropriate for the injuries as explained by the OP.

I did not say anything like this. I was only informing OP of the fact he
is entitled to pursue claim for pain and suffering. Since he doesn’t mention
broken legs. scars, or any such thing he might not get much, but I am
confident any decent lawyer could get him something for it.

@Inigo Montoya

Telling someone they were entitled to more than they got, without knowing how much they got or were owed is irresponsible and, were you qualified to make such an observation, unprofessional.

Telling someone he is entitled to full restitution for damages from a
liable 3rd party is in no way irresponsible. As for professional since
I am not getting paid anything I don’t come uder the category.

@Inigo Montoya

yeah, refers to proximity between two points in time. I was insinuating your experience as a BI adjustor is irrelevant given the amount of time you have been out of the game.

So far it looks like subrogation is the only thing I need brushing up on.
More on that later.

@Inigo Montoya

Only subrogation, OP didn’t mention calculation of a settlement or really express any curiosity about the subject.

He was definitely interested in that “shitload” he has already paid out
of his own pocket!

@Inigo Montoya

And as far as that goes, it only makes accurate things said about subrogation relevant. “Any Wildassed Guess Goes” and “How we did stuff back in the day…” is for IMHO, not GQ.

You lost me here, Bubba.

[colonial]

Back to medical bill subrogation by a health insurer:

According to this NC site:

http://raleigh.injuryboard.com/miscellaneous/beware-of-subrogation-claims.aspx?googleid=222740

Medical insurers

[ol]
[li]Do not have a right of subrogation under NC Insurance Commission regulation[/li][li]but* do* have a right of subrogation under a Federal law known as ERISA[/li][li]but cannot take a policy holder to court over it per US Supreme Court ruling[/li][/ol](from link):

In January of 2001, the United States Supreme Court held that neither an employer nor a health insurance carrier can sue an insured to enforce a subrogation clause.

However, this free legal advice site in CA seems to indicate that there
lawyers routinely include some medical subrogation allowance in their
settlement procedures:

http://en.allexperts.com/q/Personal-Injury-Law-928/medical-subrogation-1.htm

(from link, Lawyer speaking):

Your settlement will be a specific, total amount. You can not avoid the reimbursement right by try to classify a portion of your settlement as pain and suffering.

I usually do not try to settle a case until I know the total amount of the medical liens and reimbursement rights.

After a settlement is reached, and I have the settlement check in hand, I contact the lien holders and others that have a right to a portion of the settlement and negotiate a specific amount that they will accept as payment in full.

I expect that the CA lawyers are not acting as they do out of any sense
of kindliness, but because the USSC has not given them immunity from
subrogation claimant lawsuit.

Talk about a clusterfuck.

Get a lawyer.

[Really_Not_All_That_Bright]

Why would the US Supreme Court have “granted immunity” to lawyers in a particular state against claims arising wholly out of state law, exactly?

[Inigo_Montoya]

colonial, you’re making me tired. That the OP paid expenses out of pocket is not a question, it’s stated. What is not stated is whether an amount was paid that compensated the OP for that. Again, despite your hand-waving and smoke-blowing, you are not addressing my uncomplicated point: You don’t know what the OP’s injuries were, what treatment they necessitated, the cost of that treatment or what compensation was made to the OP in the insurance settlement. Therefore you have no reason to say the OP was undercompensated. What you have done is gotten more belligerent about being wrong.

As for whether or not health insurance is subrogable in NC, it looks like you’ve finally turned up something interesting. Good job. Sounds like it’s a sticky issue in NC: insurance commissioner working against a basic principle of insurance and established contract law to curry favor from the voters (OK, that was entirely IMHO-worthy).

[colonial]

@Inigo_Montoya

colonial, you’re making me tired.

Then why don’t you round up your Teddy Bear, go to bed,
and get some sleep.

@Inigo_Montoya

That the OP paid expenses out of pocket is not a question, it’s stated. What is not stated is whether an amount was paid that compensated the OP for that. Again, despite your hand-waving and smoke-blowing, you are not addressing my uncomplicated point: You don’t know what the OP’s injuries were, what treatment they necessitated, the cost of that treatment or what compensation was made to the OP in the insurance settlement.

I do not need to know what OP’s injuries were to be able
to observe that the responsbible party is liable for 100%
of the associated expense.

@Inigo_Montoya

Therefore you have no reason to say the OP was undercompensated.

I do if he paid a “shitload” as he says he did.

@Inigo_Montoya

What you have done is gotten more belligerent about being wrong.

I suspect you are pretending to be confused because your vanity
will not allow you to admit you have made a complelte mess of
your part in this discussion. Such dissimulation tends to bring out
the belligerent side of me.

@Inigo_Montoya

As for whether or not health insurance is subrogable in NC, it looks like you’ve finally turned up something interesting. Good job.

I am good at stuff like this, no thanks any of the self-procalimed
professionals who have looked in on this thread.

@Inigo_Montoya

Sounds like it’s a sticky issue in NC:

It is a sticky issue in CA too, and I expect it is everywhere due to
changes wrought by ERISA. It appears that there is now an entire
industry specializing in medical subrogation claims:

http://healthsubrogationblog.com/?p=247

I guarentee this industry did not exist in the 1970s.

More to come on medical expense subrogation, which has
piqued my interest.

@Inigo_Montoya

insurance commissioner working against a basic principle of insurance and established contract law to curry favor from the voters (OK, that was entirely IMHO-worthy).

That part has not changed since I was an adjuster, and I suspect
it is not too much different in any state.

[colonial]

Here is another lawyers’ straight dope on subrogation, highlighting
the key concept of the Made-Whole Doctrine:

Subrogation and Being Made Whole

[SIZE=3][FONT=Arial][FONT=Trebuchet MS][SIZE=2](from link, emphasis added):[/FONT][/SIZE][/FONT][/SIZE]

The made-whole doctrine is an equitable defense to the subrogation or reimbursement rights of a subrogated insurance carrier or other party, requiring that before subrogation and/or reimbursement will be allowed, the insured must be made whole for all of its damages. Precisely what being “made whole” means varies from state to state, but the concept is nonetheless fairly similar in each state. A well-respected legal treatise defines the made-whole doctrine as follows:

*It is widely held that in the absence of contrary statutory law or valid contractual obligation **to the contrary, the general rule under the doctrine of equitable subrogation is that **whether an insured is entitled to receive recovery for the same loss from more than one **source, e.g., the insurer and the tortfeasor, **it is only after the insured has been fully ****compensated for all the loss that the insurer acquires a right to subrogation. *

So OP does not owe his health insurer anything until all of his own expenses
are taken care of.

[colonial]

Well, it looks like things might not be as rosey I made out in my last post.
No suprise that Texas is odd-out again:

Subrogation and Being Made Whole, Texas Style

(from link, emphasis added):

[FONT=Trebuchet MS]Until recently, the Texas “made whole” doctrine protected injury victims by providing that they should get paid first and be “made whole” before having to reimburse their health insurance companies. After all, why should a health insurance company get their payments back? They were paid a premium to provide the medical coverage.[/FONT]

[FONT=Trebuchet MS]Unfortunately, as a result of intense political pressure from health insurance companies, recent Texas court decisions have seriously undermined the long-standing “made whole” doctrine. **Under current case law, health insurance companies now argue that they are entitled to be reimbursed from the first money recovered, and that they no longer have to wait until the victim has first been “made whole.” **[/FONT]

[FONT=Trebuchet MS]This can lead to horribly inequitable results. Take for example the situation of the accident victim with $25,000 in medical bills as a result of auto accident that was caused by a drunk driver with only $25,000 in liability insurance. The victim’s health insurance company, which has been charging exorbitant health insurance premiums, will claim that it is entitled to the entire liability policy proceeds, leaving the accident victim with nothing for her injuries. (over and above the $25k- colonial)[/FONT]

[FONT=Trebuchet MS]You know what? I think the US has the worst God Damn medical [/FONT][FONT=Trebuchet MS]health insurance[/FONT]
[FONT=Trebuchet MS]coverage system among advanced nations, and [/FONT][FONT=Trebuchet MS]the worst God Damn civil justice[/FONT]
[FONT=Trebuchet MS]system to boot. We suck. We really [/FONT][FONT=Trebuchet MS]and truly suck. [/FONT]

[Rachellelogram]

You can’t extrapolate what happens in Texas as an example for any other state in the country. Their insurance laws (work comp in particular) are so wonky that, in my company, the state has their own MASSIVE contingent of adjusters that ONLY handle Texas claims. My mom’s a work comp drug review nurse, and she’s not allowed to touch Texas.

[Inigo_Montoya]

@colonial

I suspect you are pretending to be confused because your vanity will not allow you to admit you have made a complelte mess of your part in this discussion. Such dissimulation tends to bring out the belligerent side of me.

Actually, I’ve been pretty straightforward with essentially my only objection to anything you’ve said, which was irresponsible for reason’s I’ve already explained.

You dug up the dirt on health insurance subrogation as it applies to North Carolina and I acknowleged that (despite the vanity you seem to think you see). I just checked with one of my cohorts in South Carolina, where the OP lives, and the situation is the same there–healthcare subro does not need to be honored in a settlement.

I stand behind the rest of my posts as they pertain to subrogation in a general sense. Post 6 is clear that the state matters and can influence the particulars–in this case whether the healthcare insurer has a subrogation right at all.

[Lasciel]

@Inigo_Montoya

I just checked with one of my cohorts in South Carolina, where the OP lives, and the situation is the same there–healthcare subro does not need to be honored in a settlement.

I stand behind the rest of my posts as they pertain to subrogation in a general sense. Post 6 is clear that the state matters and can influence the particulars–in this case whether the healthcare insurer has a subrogation right at all.

Pardon the continuing density of the OPer, but am I understanding you correctly that the health insurance company can’t actually collect on this subrogation request to me?

If that is correct, then why are they sending it to me anyway? Wouldn’t it be easier to simply make a claim against the other dude’s car insurance policy in the first place?

Or am I understanding things all wrong again? (Totally possible, I understand.)

[Really_Not_All_That_Bright]

@Really_Not_All_That_Bright

Why would the US Supreme Court have “granted immunity” to lawyers in a particular state against claims arising wholly out of state law, exactly?

colonial?

@Lasciel

Pardon the continuing density of the OPer, but am I understanding you correctly that the health insurance company can’t actually collect on this subrogation request to me?

If that is correct, then why are they sending it to me anyway? Wouldn’t it be easier to simply make a claim against the other dude’s car insurance policy in the first place?

Most likely because they simply don’t know who the other dude’s car insurance carrier is and don’t want to bother investigating when they can just ask you. They probably don’t even know that another party was at fault.