Even if you are injured due to the negligence of another (who rightfully should 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. There are all sorts of other tactics a good personal injury lawyer will use to negotiate down these health insurance bills. Among them, your Miami personal injury lawyer should argue the following, if possible:
- Unrelatedness – some medical bills paid for by the health insurance company may not be related to the injury (e.g. seeing a cardiologist for chest pains after an orthopedic injury may, arguably, not be not related).
- Some part of the recovery may not be for medical bills. There may be a significant lost-wage component and pain and suffering. A settlement agreement between the tortfeasor and the injured party can clear up how the tortfeasor intended to allocate the money.
- Comparative negligence or limited insurance policy. A settlement or verdict may not be wholly compensating a personal injury client for his or her injuries if a percentage of fault is assigned to the injured party and the verdict/settlement was reduced accordingly; or if the personal injury victim’s damages far exceed the insurance policy. In a settlement situation, these issues can also be made clear in a settlement agreement.