Reimbursing medical insurance carrier after settlement received?

by Anonymous

My wife was rear-ended in 2010. Rather than retain a lawyer, my wife negotiated with the at-fault driver's insurance company.

That insurance company paid for the repairs to my wife's car. For months, my wife received medical treatment and forwarded the bills to the at-fault driver's insurance company. **My wife's health insurance company paid for the medical treatment the whole time.**

Now the at-fault driver's insurance company has offered my wife a lump sum settlement. My question: If my wife accepts the settlement payment, is she then obligated to reimburse her health insurance carrier for the bills they have already paid? Thank you.

Visitor Question:
Disclaimer: Information provided in our response is NOT formal legal advice. It is generic legal information based on the very limited information provided. Under no circumstances should the information in our response, or anywhere else on this site be relied upon when deciding the proper course of a legal matter. Our response does NOT create an attorney-client relationship. Always get a formal case review from a licensed attorney in your area.

ANSWER for "Reimbursing medical insurance carrier after settlement received?":

The law does not penalize a person for purchasing health insurance. Your insurance company should not ask your wife to reimburse them. Rather they will probably “Subrogate” against the at-fault driver. Subrogation means your wife’s insurance company may demand reimbursement for the medical bills not from your wife, but from the at-fault driver.

In the facts you present you mentioned the insurance company is preparing to offer your wife a lump sum settlement. That may be well and good, but you should be on guard against a lump sum settlement from the at-fault driver’s insurance company. Insurance companies are businesses. You shouldn't mistake their interest in settling the case as compassion. People can be compassionate. Businesses almost always won't be.

Be aware a lump sum settlement should include reimbursement for Medical Bills, Out of Pocket Expenses, Lost Wages, and Pain and Suffering. We are not quite sure what you and your wife based your demand for settlement upon. Hopefully you included the above factors, especially a substantial amount for Pain and Suffering.

Negotiating a settlement for Pain and Suffering can be complicated. The Claims Adjuster with whom your wife has been negotiating may act sincere, and may in fact be sincere, but sincerity is not the issue here. Once a settlement has been finalized it is just that, finalized.

Although we cannot guarantee an Attorney’s intervention (and review of the proposed settlement agreement) will result in a higher lump sum settlement, we can tell you that sitting with a Skilled Personal Injury Attorney will at a minimum afford you and your wife some degree of comfort knowing the proposed settlement is appropriate. In the alternative the attorney may convince you the settlement is well below the appropriate amount which should be offered.

Do not be concerned that seeking the advice of a Personal Injury Attorney will automatically cost your wife part of the settlement. It is not that way. Most Skilled Personal Injury Attorneys will not charge at all for an initial office consultation.

If after the consultation the Attorney convinces you the amount is substantially lower than it should be, she may be able to intervene in the settlement negotiations for an agreed fee; one in which she guarantees you at a minimum you will receive no less than the amount the insurance company has already offered. In that case any amount greater than the amount offered by the insurance company will be a “bonus,” or additional amount of money for your wife.

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from an attorney licensed in your state. Find a local attorney to give you a free case review here, or call (888) 647-2490.

Best of luck,

Judge Calisi

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