When a
person gets injured, the last thing they are thinking about is how the various
insurances interplay with one another. The first thing that should always be
focused on is getting the necessary medical treatment. At our firm, we have a
textured knowledge of insurance law and how each policy affects the other and
we can unwind the confusing mess that a personal injury claim becomes. This
allows our clients to focus on the treatment they are receiving, while we focus
on getting the right insurance to pay for our client’s medical bills.
There
are three basic sources for payment of medical bills. The first is obvious, and
it the health insurance for our clients. The second is no fault coverage, and
not everyone is aware that this provision in your automobile policy covers
medical bills from an accident. This takes the form of “medical payments
coverage” in New Hampshire, and “personal injury protection (PIP)” in
Massachusetts. Our attorneys are very familiar with both types of insurance,
and can help utilize these sources to reduce your obligations at the end of the
case.
If your
health insurance pays bills, then the health insurer has a right of recovery
against our client’s settlement or judgment called a “subrogation” right.
Often, the health insurer will send our office a notice requesting a lien on
the file. This is due to the fact that a person injured in an accident is not
allowed to get a “double recovery”. This would be where health insurance pays a
bill, and then the client takes a settlement that includes compensation for
those bills but does not pay the health insurer back. This right of subrogation
by a health insurer is a contractual right included in the health insurance
policy. Accordingly, it almost always must be paid back.
If a
client has Medicare, Medicaid or Tricare (a/k/a “military”) insurance, then
each has a statutory right to be paid back from a settlement or judgment our
clients secure. This is based on the same “double recovery” principle, except
the rules are much stricter and coordination of benefits becomes very
important. Medicare, especially, can create significant delays in resolving
these subrogation liens, so it is always important to talk to an attorney about
your rights in your case.
There
are other forms of liens in Massachusetts, including statutory hospital liens.
In all cases, the interplay of the various insurances involved become very
important to coordinate. For example, the medical payment coverage referenced
above does not include any subrogation rights. This means that if your medical
payment portion of your policy pays a bill, then they cannot recover that
payment from the settlement or judgment. Thus, it becomes very important to
find an attorney with a detailed knowledge of the insurance rules and how liens
on injury files work.
Personal
injury cases are complex and require the assistance of experienced attorneys to
help you navigate the various pitfalls and maximize the value of your case. If
you were injured and need assistance,
contact our office today and
put our decades of experience to use.