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Health Insurance Effects on Personal Injury Case - Hospital Treatment and Care Expenses

man talking to insurance company

After being injured in an accident, some of our clients from the Palm Coast and Ormond Beach area have questions about what medical expenses their health insurance should cover and what expenses a personal injury claim is meant to pay. This gets to the crux of what a personal injury claim is about – ensuring that there’s no cost to an innocent accident victim.

In Florida, car accident victims may look first to their own no-fault insurance policies to cover their medical bills before pursuing a personal injury claim. In addition to health insurance, all Florida car owners are required to hold personal injury protection (PIP), a type of no-fault auto insurance. Under the basic PIP coverage, which almost everyone has, injured drivers have up to $10,000 in immediate medical coverage. 

If your injuries are serious and far exceed the limits of PIP insurance, then you may need to pursue compensation through a personal injury claim, which seeks to establish fault and compel payment through the court system. A Florida personal injury claim over a car accident must be for injuries that have cost the victim more than $10,000 to be viable. 

Someone with health insurance and medical bills to pay might wonder whether they should rely on the health insurance and how doing so might affect a personal injury claim.

The short answer is that you should use your health care coverage to help with your medical bills after an accident up to the limits of your coverage. Doing so may help you avoid amassing large amounts of medical debt. If you file a personal injury claim and receive a settlement or court award, the proceeds would be used in part to reimburse your health insurance company. In the end, the insurer holding the coverage for the at-fault driver is the party that pays the damages – not you and not your health insurer.

 At Chiumento Law, PLLC, we can advise you about pursuing a personal injury claim after an accident that was someone else’s fault and help you deal with insurers. We can make a full accounting of your costs and losses and negotiate with insurers to ensure that you receive all of the compensation you are due. 

Health Insurance and Your Personal injury Claim

Personal injury claims are meant to ensure that people injured in accidents caused by some other party’s negligence are not also financially harmed by the other party’s negligence. This applies to a variety of cases, such as car accidents, truck accidents, slip-and-fall accidents, dog bites, and many other incidents.

A personal injury claim demands compensation, or “damages,” for:

  • Medical costs related to the accident
  • Future medical expenses related to the accident/injuries
  • Wages lost while out of work recovering from the accident/injuries
  • The potential loss of income in the future
  • Pain and suffering
  • Emotional distress
  • Property damage or destruction.

After being injured, your primary concern will be to obtain medical care and start down the road to recovery. As you receive care, the hospital, doctors, and therapists will file insurance claims with your health care insurer. When your insurer enquires about your need for medical care and finds out you were in an accident, it will investigate and find out that someone else caused the injuries. They will want their money back.

If a government agency paid for any portion of your medical care after an accident (Medicare, Medicaid, Veteran’s Administration, etc.), they usually have a right to seek repayment if another party paid you for the same expenses.

‘Subrogation’ and Liens Against Your Recoveryclient meeting with a lawyer

Your health care insurer will want to recover its costs if someone other than you caused those costs. Your insurer may file a lien against your claim to recover what it has paid out on your behalf if you have a pending personal injury claim. This is known as subrogation.

In reference to a legal debt or claim, to subrogate is to substitute one person or entity for another. In a personal injury claim, subrogation of medical expenses ensures that, in the end, the party at fault pays the medical bills, which typically means their insurer pays, not yours.

However, how much of a personal injury settlement or award an insurer can actually claim through subrogation may be negotiable.

What you, as the plaintiff in a personal injury lawsuit, may receive in compensation is generally limited to the amount of insurance coverage the at-fault party, or defendant, has. In Florida, courts have applied the made whole doctrine, which says the insured individual is entitled to be made whole financially before the subrogated insurer can obtain a portion of proceeds from a claim.

The result of the made whole doctrine and related law is that a medical lienholder may accept less than what they paid out. Private health insurance providers already pay different rates for the same services. Medical providers are used to payments fluctuating according to negotiations.

Our attorneys at Chiumento Law, PLLC are experienced at handling Florida personal injury cases on how to negotiate subrogation claims with insurers. We will calculate the full extent of your losses and seek to negotiate subrogation liens, as well as subrogation personal injury settlement, in your favor. Our aim is to ensure that you recover and actually keep as much money as possible when all is said and done with your claim.

How Our Personal Injury Attorneys Can Help

Insurance companies use formulas to determine what they will pay for injury claims or seek to recover in a lien against your claim. Our attorneys recognize that each individual’s accident, injuries, costs, and losses are unique and not addressed by a one-size-fits-all formula. We will evaluate the details of your injury and multiple other factors that contribute to the total value of what you are owed as compensation for your losses.

A knowledgeable personal injury lawyer at Chiumento Law, PLLC can offer an informed perspective on the value of your claim based on the details of your case as well as our experience with similar cases. Our trusted attorneys have more than 45 years of experience helping clients across Flagler and Volusia counties seek maximum compensation after devastating accidents.

Contact Chiumento Law, PLLC to discuss your accident and protect your rights to compensation after an accident that was not your fault. Call us today at (386) 445-8900 or contact us via our online contact form.

 

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