Recovery of Expenses Paid Previously By Health Insurer

Anyone injured in an accident can file a personal injury claim. That action allows the accident victim to seek fair compensation for any damages. The legal system recognizes that fact.

Yet the same legal system gives a nod to the practice known as subrogation. That is the process whereby a health insurance company seeks reimbursement for the money spent on a victim’s treatment. That process begins with the sending of a letter.

What should be in the letter that a health insurance company sends to the victim of an accident?

Questions about the accident’s location: Did the policy holder get injured at work? Was a 3rd party involved?

A question that asks this: What is the name of the insurance adjuster for the party at fault?

An inquiry into the recipient’s plans. Will he or she be hiring an injury lawyer in Richmond Hill?

The carrier of the health insurance asks such questions, because that same company has the right to claim full reimbursement for its earlier coverage of the injured victim’s medical expenses.

How the recipient should respond to such a letter?

The letter’s recipient should study his or her health insurance policy. Does it authorize the use of subrogation? In the absence of written authorization, a health insurance company has no right to demand some portion of an accident victim’s settlement.

The role of subrogation, following a workplace injury:

Subrogation’s role in that situation depends on the type of health insurance purchased by the injured worker’s company. Did the company’s boss elect to self-insure all health claims? If that is the case, then the self-insured claims can give rise to a legitimate claim on part of the settlement.

Who could make that claim? That claim would come from the company that had carried the health coverage for the accident victim. In other words, the subrogation process can proceed if an employer has self-insured all health claims.

Employers that fail to self-insure such claims manage to impede completion of the subrogation process. In other words, their action works to alter the legality of that particular process. Naturally, a company that carries health coverage for a company’s workers, would not want to try performing an illegal action against the business that had purchased such coverage.

Who handles the paperwork that gets created when a health carrier chooses to subrogate a settlement?

Normally that paperwork gets completed in the office of the attorney that was hired by an injured victim. Smart victims hire a lawyer, in hopes of acquiring assistance with various legal procedures. One such procedure calls for completion of the paperwork that arose from a health carrier’s pursuit of the procedures that are linked to subrogating a reimbursement for the payment of medical expenses.

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