Even if you are injured due to the negligence of another (who should rightfully pay for your medical care), having health insurance makes it much easier to receive ongoing medical attention from any doctor you desire that accepts your health insurance plan. However, the health insurance company (per their contract) will have a right of reimbursement from any recovery received from the negligent party in a personal injury action.
But, the health insurance company’s right to reimbursement is limited, per FL. Stat. §768.76, to the plaintiff’s recovery less the plaintiff’s pro rata share of costs and attorney’s fees incurred in its effort to make the recovery. In other words, the health-insurance company entitled to reimbursement must discount the amount owed by the same percentage of the recovery/judgment that went towards attorney’s costs and fees.
The health insurance provider will also need to consider (because if they do not, a judge will do it for them) the apportionment of liability, which would decrease the plaintiff’s recovery, liability insurance policy limits that may be less than what a plaintiff would have received had there been more coverage, and other extraordinary factors that should be taken into consideration. If there are medical liens over and above what was covered by health insurance, those will need to be considered as well.
Part of my job as your miami to lakeland personal injury attorney is to negotiate these liens down as much as possible. This will include: reading your health insurance contract to determine exactly what is reimbursable. Comparing what a doctor might have charged to what they actually received from the health-insurance company (insurance companies tend to negotiate lower reimbursement rates for services performed by doctors who participate in their health insurance plan). The health insurance company is only entitled to be reimbursed what they actually paid – not what the doctor charged.
Understanding how the health insurance company’s rights are limited depending on the type of action initiated is important. For example, they will usually not be entitled to reimbursement out of uninsured motorist policy recoveries. In addition, wrongful death actions are for the benefit of the deceased’s survivors – to compensate them for their pain and suffering (as opposed to a survivor’s action, which will be covered in another post), and so the health insurance company will not be entited to reimbursement from that kind of recovery. Similarly, if part of a personal injury recovery is for loss of consortium (which is a claim that belongs to the injured party’s spouse), the health insurance company will not be able to touch that portion of the recovery either.
We also have to look out for situations where the health insurance company is demanding to be reimbursed for a medical expense unrelated to the subject personal injury.