Health Insurance Subrogation Reimbursement Claim After an Accident

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You have been the unfortunate victim of a car accident. You have sustained some injuries from the crash and were checked out at a local hospital, which then recommended that you obtain follow-up care from your primary care physician. You followed doctors orders and your car accident attorney is prepared to submit a settlement demand to the car insurance company for the at-fault party.
There is a roadblock. You have health insurance, who has paid some of your medical bills.
Your health insurance company has sent you or your attorney a “subrogation questionaire” and is asking questions about how the car crash took place and information on all of the car insurance companies involved in the handling of the claim. Your response to this line of questioning will ultimately have a direct impact on the amount of money you actually pocket from your injury claim.

Health Insurance Subrogation Liens

Health insurance companies are all over personal injury settlements. They want to be reimbursed for the costs they had to pay hospitals and doctors to treat you for injuries from the car accident. These health insurance giants argue that if you are getting a settlement for your injuries, shouldn’t they share in some of the economic recovery.
As an experienced accident injury lawyer who handles these situations on a daily basis, I say “NO WAY”! Health insurance companies can make the life of an injury victim more difficult that it already is by essentially robbing you of fair compensation by asserting a “health insurance subrogation lien” on your injury case. They will contact the car insurance company of the at-fault and demand that you are not paid any kind of settlement until their subrogation lien is paid. How unfair is that? We think it is very unfair!

So can a health insurance company get some of your settlement money?

The answer is not simple and it depends on several factors.
First and foremost, a lawyer must go over your actual health insurance contract carefully to determine whether there is a reimbursement (aka “subrogation”) provision in the contact.
Second, your attorney must research whether that particular subrogation provision, if it exists, is actually enforceable in your specific situation.
Third, your lawyer will request various documents from your health insurance company to determine whether they are claiming “ERISA” privileges. Lastly, your personal injury lawyer will fight to invalidate the health insurance subrogation claim.


At the very least, your lawyer will seek a modest reduction in any reimbursement claim. In some cases, the seasoned injury attorneys at our Missouri law firm are able to void the health insurance subrogation claim altogether!
If you do not have a lawyer and engage health insurance subrogation on your own, one of two things are certain to happen.
First, you will end up reimbursing the full amount of the subrogation lien to your own detriment.
Second, you will attempt to invalidate the lien and your own health insurance company will file a lawsuit against you or cut off all benefits from that point forward.
These are two potential outcomes that you do not want! At the very least, do your due diligence and contact a St. Louis injury attorney to discuss any health insurance subrogation issues in your case. It is important to instruct your lawyer to deal with these important issues. Some lawyers do not fully understand health insurance subrogation laws and will either run from the lien or pay too much to settle it.

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