Subrogation refers to an insurance company´s reimbursement for claims paid out as a result of an accident. In cases of health insurance subrogation, your health insurance company may seek compensation for claims paid as a result of an accident when the accident resulted from a third party's liability. Health insurance companies can only seek reimbursement through subrogation after paying out claims. Thus, through subrogation, insurance companies try to hold third parties accountable for the claims the insurance company has already paid out.
A Subrogation Claim
When your health insurance company pays claims relating to an accident, in some cases your health insurance company may receive reimbursement for the claims paid out. A subrogation claim is the insurance terminology for this kind of claim. In cases of subrogation, your health insurance company will mark your case with a lien. Per the terms of your insurance policy, your health insurance company has a right to request your assistance in pursuing a subrogation claim against a third party. In this case, your insurance company requires you to reimburse expenses already paid by the insurance company out of your settlement with a third party. This will satisfy the lien placed on your case by your health insurance company.
Health Insurance Policies
Because your health insurance company has a vested interest in a settlement with a third party, your insurance company may help you reach a settlement with a third party. For example, in the case of an automobile accident, your health insurance company may work with you and your automobile insurance company to reach a settlement. Every health insurance policy is different, so make sure you understand your specific insurance policy and any subrogation verbiage included in the contract.
If you want to avoid subrogation, it is important to understand your health insurance policy and any subrogation rights your health insurance company receives under the terms of your contract. Many policies have specific clauses dealing with subrogation in the event of a personal injury lawsuit. You also may hire legal council to advise you of your specific rights based on your specific personal injury case. In some cases, a lawyer can also file an injunction against the proposed subrogation to block the lien.
Subrogation is a complex area of the law. Therefore, professional organizations and lawyers specializing in subrogation exist to assist you in navigating through subrogation issues. A specialist in subrogation can help you understand your rights and obligations and discuss alternatives with you. However, depending on your health insurance contract, the insurance company still may have the right to file a lawsuit against the responsible party on your behalf.
- Settlement Central: Introduction to Subrogation---Forced Payback to Your Own Insurer From Your Personal Injury Award
- Injury Attorney SMN: What is Health Insurance Subrogation? October 2010
- "ERISA and Health Insurance Subrogation - In All 50 States; Gary Wickert; November 2008
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