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Counsel That You Can Trust & Depend On

Will My Health Insurance Take My Personal Injury Settlement Money?

Guy DiMartino Jan. 22, 2015

This is a common question that I receive from clients all the time. Most people believe that since they are paying for their health insurance or it is provided as a work benefit, that they should not have to pay back the insurance company for any medical expenses it paid for accident related injuries.

This is a very complicated question and it has developed a niche area of practice where law firms only deal with insurance companies. Generally, if your health insurance has paid money for hospital or medical expenses it will have a right of reimbursement.

The complexity comes in if the Group Plan is a self-insured plan under a federal law called ERISA. In these situations the plan can receive all the money that it had paid out even if it is more than the amount of the settlement.

The United States Supreme Court has not helped injured people with these issues. This is something that needs to be looked at and discussed early on in any accident case. Sometimes, it is best just to walk away from the claim if the ERISA carrier is going to be jerky about its right of reimbursement, otherwise all you are doing is becoming a collection agent for the insurance company.

The most important aspect to handling these issues is getting on the phone with the insurance company as early as possible so we can set up an agreement that they will work with us and our clients at the time of settlement.