Will health insurance go after us if we don't sue the at-fault third party?

by A

My husband fell down the porch steps in the home we rent, because the stairs broke. They were due to be fixed by the homeowner 5 days after he fell, which is unfortunate. I gave the Emergency Room my Blue Cross card because they needed proof of insurance.

I got a letter from BC stating they think a 3rd party may be liable. It said that by signing the form and sending it back, we agree that any proceeds from a suit against the homeowner's insurance go back to them for repayment.

My question is this: Do we HAVE to sue the 3rd party? If we don't, does BC come after us? Also, if we do sue, and lose, will BC still cover his care? Our policy with BC is vague on this issue, after reading it. Thank you.

Visitor Question:
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ANSWER for "Will health insurance go after us if we don't sue the at-fault third party?":

A (USA):

Fortunately, you do not have to sue the third party homeowner. What Blue Cross means is they will be happy to pay for all your husband's medical bills covered under the policy. The only requirement is for you to assign to them any proceeds from a settlement or lawsuit your husband might receive if he decides to proceed with an injury claim against the homeowner.

However, your husband is under no legal or contractual obligation to do so.

With that said, it is likely Blue Cross wants to "subrogate" against the homeowner. This means, by signing the form they sent you, you are assigning to them any proceeds they may recover against the homeowner based on his negligence in not timely repairing the steps.

In other words, subrogation simply means the insurance company wants their money back. But not from you or your husband. They want their money back from the homeowner. The homeowner's negligence was the direct cause of your husband's injury, and the insurance company's resulting obligation to pay out under your husband's policy.

At this point, your husband doesn't really don't have to do anything other than cooperate and sign the form. All you can do is sit back, and let the insurance company do what it does. You and your husband should not be concerned about anything except his recovery.

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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