Can my health insurance ask me to repay the medical bills incurred because of an auto accident?
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Can my health insurance ask me to repay the medical bills incurred because of an auto accident?
I was in an auto accident (other person’s fault). I have been getting treated for the injuries and I have been using my health insurance (obtained thro’ employer) for the treatment. Now the health insurer is asking for repayment of the bills because it is an auto accident. Is this legal?
Asked on April 30, 2012 under Accident Law, California
Answers:
S.L,. Member, California Bar / FreeAdvice Contributing Attorney
Answered 11 years ago | Contributor
Some insurance companies require reimbursement. When you complete your medical treatment and are released by the doctor or are declared by the doctor to be permanent and stationary which means having reached a point in your medical treatment where no further improvement is anticipated, obtain your medical bills, medical reports and documentation of any wage loss. Your personal injury claim should include these items which should be submitted to the at-fault party's insurance carrier. When the case is settled, the settlement will have to be sufficient to both reimburse your insurance carrier and compensate you for the medical bills, pain and suffering and wage loss. Compensation for the medical bills is straight reimbursement. Compensation for wage loss is straight reimbursement. Compensation for pain and suffering is an amount in addition to the medical bills and is determined by the medical reports which document the nature and extent of your injury. If the case is settled with the at-fault party's insurance carrier, NO lawsuit is filed. If you are dissatisfied with settlement offers from the at-fault party's insurance carrier, reject the settlement offers and file a lawsuit for negligence against the at-fault party. If the case is NOT settled with the at-fault party's insurance carrier, you will need to file your lawsuit for negligence against the at-fault party prior to the expiration of the applicable statute of limitations or you will lose your rights forever in the matter.
As for the reimbursement of your insurance carrier, it may be possible to negotiate with the company to try to have them accept less than 100% reimbursement. This may or may not be applicable with your particular insurance carrier.
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