You settle your injury claim for one amount, but that does not always mean the entire amount ends up in your pocket. If your health insurance, auto insurance, Medicare, or another benefit provider paid accident-related expenses, it may have a right to seek some of that money back. This process, known as subrogation, can affect what remains after your case is settled.
Hollis Law Firm helps injured clients understand these repayment claims as part of the larger settlement process. A car accident claim can involve several sources of payment for medical care, each with different reimbursement rules. We can help you identify who may be seeking repayment, how those claims affect the settlement, and what needs to be resolved before the funds are distributed.
How Does Subrogation Work After an Accident?
Your insurance may pay accident-related bills even when someone else caused your injuries. If your policy grants the insurer subrogation rights, it may later seek reimbursement from the responsible party, usually after you receive a settlement or other recovery. You or your attorney may receive notice of the insurer’s reimbursement claim, which may need to be addressed before the case is fully resolved.
A repayment claim can reduce the amount you take home from a settlement, particularly when more than one insurer or benefit provider is involved. You may also hear from the at-fault party’s insurance adjusters while your case is open, so be careful about discussing your injuries, medical bills, or settlement directly with them. Your attorney can review any reimbursement claims, determine what must be repaid, and factor those amounts into settlement discussions.
Who Can Claim Subrogation Against Your Settlement?
More than one insurer or benefit program may have a right to recover money it paid toward your accident-related care. Depending on the coverage involved, that could include:
- your private health insurance plan, including coverage through an employer
- medical payments coverage through your auto insurance
- Medicare for certain conditional payments
- Medicaid for accident-related medical expenses it paid
The rules are not the same for each one. How much must be repaid can depend on the type of coverage, the terms of the plan, and the laws that govern it.
The Centers for Medicare & Medicaid Services explains that Medicare may make conditional payments for care when another payer is ultimately responsible. Those payments may have to be repaid after a settlement, judgment, award, or other payment. CMS also gives recipients 30 calendar days to respond to a conditional payment notice before it automatically issues a demand letter without reducing the amount for attorney fees or costs. That means that Medicare notices are something you and your attorney should address rather than set aside while the injury case is pending.
How Can Subrogation Change the Amount You Receive?
A subrogation claim comes out of your settlement, so a larger claim may leave you with less. Imagine you settle your case for $60,000, and your health insurer paid $15,000 toward accident-related treatment. The insurer may ask that some or all of that $15,000 be deducted from the settlement, in addition to attorney fees and case costs.
Your total recovery also depends on how damages are calculated, which includes more than medical bills. Knowing the size of any claim early helps you make decisions with accurate numbers.
Can a Subrogation Claim Be Reduced?
Many subrogation claims are open to review. Our lawyer may review the insurer’s records to confirm that each charge relates to your accident, as a claim can include treatment unrelated to it. Our lawyer may also assess whether the law applicable to your plan limits the insurer’s right to repayment. Our lawyer may then ask the insurer to accept a lower amount, especially when attorney fees and case costs reduced your recovery. Negotiating medical bills and liens this way may increase the portion of the settlement you keep.
What Should You Do If You Receive a Subrogation Letter?
Start by keeping the letter and sending a copy to your lawyer right away. Tell your lawyer about every insurer that paid for your care, including health plans, auto medical payments coverage, and government programs, so no claim catches you off guard. Avoid agreeing to a repayment amount on your own, because early answers may limit your options later. Taking these steps before accepting a settlement offer may give you more room to negotiate.
Contact Hollis Law Firm About Subrogation and Your Settlement
A subrogation claim can affect how much of an injury settlement you actually receive, so it’s important to account for repayment demands before the case is resolved. Hollis Law Firm can review claims from health insurers, auto insurers, Medicare, Medicaid, and other benefit providers and determine how they may affect the money available to you after a settlement.
Managing attorney Jason Chambers represents people injured in car and truck accidents, brain injury cases, and other personal injury matters. He can review your case, including any reimbursement claims related to your medical care, and explain what needs to be addressed before settlement funds are distributed. Consultations are free, so if you have questions about subrogation and your settlement, contact our office to speak with our attorney.
