When receiving a personal injury settlement in what cases, if ever, do you have to pay back your insurance company? 26 Answers as of May 16, 2013

I am receiving a settlement in a personal injury lawsuit. I have no due medical bills as my insurance company paid them all when the injury happened. In what case, if ever, do I have to pay back my insurance company for paying those bills?

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William Rawlings & Associates | William Rawlings
If you received the responsible party's Policy limits as part of your settlement, your own carrier has no subrogation rights against your settlement for any medical they paid. They are also required by statute to waive any subrogation claim for any money paid to you from an Underinsured Motorist claim where policy limits were tendered by the responsible party's carrier. However, if policy limits were not paid, they do have a right to recover any medical paid to you out of the settlement. As a general rule, the responsible party's carrier will reimburse your Insurance Company directly.
Answer Applies to: Utah
Replied: 5/16/2013
Montgomery Law Offices
Montgomery Law Offices | Gary Montgomery
Most insurance policies contain a subrogation clause. This means that if you collect any money against the at fault party in your accident claim, then you are obligated to repay your own insurance company for any payments they have made on your behalf for medical bills. So you have check your insurance policy or call your insurance agent and ask them if there is a subrogation clause in the policy.
Answer Applies to: Idaho
Replied: 5/15/2013
End, Hierseman & Crain, LLC | J. Michael End
The answer to your question depends on the type of health insurance paid the bills. There are different rules that apply to different kinds of insurance. If your employer paid the bills through an ERISA plan, your employer is entitled to be paid back for everything it spent. On the other hand, you have a better chance to negotiate if the health insurer was simply a standard insurer. Handling subrogation interests of health insurers is something that lawyers know how to deal with.
Answer Applies to: Wisconsin
Replied: 5/15/2013
Gregory M Janks, PC
Gregory M Janks, PC | Gregory M Janks
If you are talking your No Fault car insurance company the answer is usually "no" you do not have to pay them back (there are a couple of circumstances re: out of state insurers where you may have to pay them back, but I presume those don't apply to you - but to know for sure, ask your lawyer or get a consultation with a lawyer handling these cases). If you are talking workers compensation insurance, then typically they do have a right of reimbursement. Again, ask your lawyer and/or consult with a lawyer with all your specific facts vs. the general ones stated hereon.
Answer Applies to: Michigan
Replied: 5/15/2013
James E. Hasser, Jr. P.C.
James E. Hasser, Jr. P.C. | Jim Hasser
Almost all medical insurance policies have "subrogation" provisions which allows the insurance company to get its money back out of any settlement or judgment. Good luck.
Answer Applies to: Alabama
Replied: 5/15/2013
    Gini Lynn Jenkins Attorney, LLC of counsel with Kelly & Kelly, LLP
    Gini Lynn Jenkins Attorney, LLC of counsel with Kelly & Kelly, LLP | Gini Lynn Jenkins
    It depends on whether your health insurance contract falls under Georgia law or a federal law scheme known as ERISA. Even if an ERISA plan, you may not have to pay the plan back. It depends on a few factors and the language of the plan. It can be quite complicated. If your plan is subject to GA law, then the insurer is only entitled to reimbursement if you have been completely compensated by the settlement which you were likely not. I recommend you hire an attorney for a couple of hours to review your documents and advise you.
    Answer Applies to: Georgia
    Replied: 5/15/2013
    Law Offices of Ronald A. Steinberg & Associates | Ronald A. Steinberg, BA, MA, JD
    It depends on which insurance company paid the medical bills. If it was your health insurance company, then you have to pay back up to the complete amount that they paid, depending on how much money you recovered. If it is your auto company that paid, then you don't have to pay them back.
    Answer Applies to: Michigan
    Replied: 5/13/2013
    Peters Law, PLLC
    Peters Law, PLLC | Mark T. Peters, Sr.
    Yes, your insurance company is subrogated to the rights of the providers and is entitled to be reimbursed. Your attorney may be able to get them to take less than full values on the basis that the attorney's work helped the insurance company get its money back.
    Answer Applies to: Idaho
    Replied: 5/13/2013
    Derek L. Hall, PLLC | Derek L. Hall
    If you are represented by an attorney, please ask them. Generally, if an insurance company pays your medical bills, they will want to be reimbursed. Whether you are required to or not depends on the specific language of your insurance policy.
    Answer Applies to: Mississippi
    Replied: 5/15/2013
    Hone Law Firm
    Hone Law Firm | John S. Hone
    In any case in which your medical insurer has a lien or subrogation right per the contract, or statute.
    Answer Applies to: Michigan
    Replied: 5/15/2013
    Curry, Roby & Mulvey Co., LLC
    Curry, Roby & Mulvey Co., LLC | Bruce A. Curry
    The insurance company would always have a right to be repaid unless 1.) it waives that right, or 2.) the value of your claim exceeds the tort feasor's liability policy limits and the repayment (subrogation) provisions of your own insurance policy do not clearly and unambiguously state that it's right to recovery even if you have not been fully compensated (been made whole).
    Answer Applies to: Ohio
    Replied: 5/15/2013
    Paul Whitfield and Associates P.A.
    Paul Whitfield and Associates P.A. | Paul L. Whitfield
    Your insurance policy may have a provision in it which says that they will pay but will be reimbursed if your claim is paid by a third party (another insurance co) this is called "subrogation" Normally the carrier will write you and ask you about such things or write and remind you or write and file a "lien notice" or some such. you should review your policy yourself and ask an attorney to do so. Do not ask your insurance company. (don't wake them if they are asleep) also, don't ask them. they will probably claim a right to reimbursement even if they don't.Have one. never trust an insurance co to do the honorable thing. They are in business to make money and will rook the consumer every time they get a chance.
    Answer Applies to: North Carolina
    Replied: 5/15/2013
    Law Office of Mark J. Leonardo
    Law Office of Mark J. Leonardo | Mark Leonardo
    The answer is yes but they have to share in the attorney's fees you pay. So for example, if the medical bills they paid total $3,000 and your attorney charged you 1/3 in fees and costs, the medical bills get reduced by 1/3 (i.e., $1,000) so you only pay them back $2,000. However, depending on the circumstances the amount reimbursed can be negotiable and sometimes even waived; a lot depends on how much you recovered in relation to the amount the insurer paid.
    Answer Applies to: California
    Replied: 5/15/2013
    Lombardi Law Firm
    Lombardi Law Firm | Steve Lombardi
    Which insurance company paid the bills? Your health insurance, your auto insurance or some other insurance company?
    Answer Applies to: Iowa
    Replied: 5/14/2013
    David F. Stoddard
    David F. Stoddard | David F. Stoddard
    In most cases your health insurer has a clause in its policy that gives it a subrogation right to any lawsuit that you may have to recover the cost of the bills they pay. Whether you can get out of repaying your insurer depends on whether your insurer's policy does not have such a clause, which is rare, and some complicated rules on whether you were put on notice of their subrogation interest.
    Answer Applies to: South Carolina
    Replied: 5/14/2013
    Frank Law Group, P.C.
    Frank Law Group, P.C. | Brett E. Rosenthal
    Depends on the language of your policy. If your medical bills were paid under you Medical Payments provision, it depends if includes a reimbursement clause. You need to request the policy provision from your own carrier under which they are claiming right to reimbursement. Even assuming there is such a clause they will typically negotiate some reduction for fees and costs.
    Answer Applies to: California
    Replied: 5/14/2013
    Law Office of Russell D. Gray, PC
    Law Office of Russell D. Gray, PC | Russell D. Gray
    It depends on the insurance company. Most of the time, a health insurance provider will assert a lien, which means they get paid back from the injury settlement/verdict. The health insurance company contract almost always says they have this right, and when the contract says they have the right they almost always claim a lien and have to be paid back.
    Answer Applies to: Utah
    Replied: 5/13/2013
    Lawrence Kahn Law Group, P.S.
    Lawrence Kahn Law Group, P.S. | Lawrence Kahn
    If your insurance company paid your medical bills through our auto insurance Personal Injury Protection (PIP), the contract has a repayment clause. However, the insurance company must, under WA law, pay its share of attorney fees and costs in getting that money back. If your insurance company is a health insurance company, you need to read the policy language to determine the extent of repayment.
    Answer Applies to: Washington
    Replied: 5/14/2013
    Burkhalter, Rayson & Associates, P.C.
    Burkhalter, Rayson & Associates, P.C. | David A. Burkhalter, II
    Most insurance companies that pay medical expenses require reimbursement of the amount they paid upon settlement with the at fault driver's insurance company, so does Medicare/Medicaid. The right to reimbursement can be contractual and/or statutory. This issue has to be dealt with by you as it can hold up payment of a settlement and/or you could be setting yourself up to be sued down the road should they find out you got a settlement and failed to reimburse them. However, my experience is that a lawyer can negotiate the amount of the reimbursement and end up getting the insurance company to agree to accept less than full payment of their claim, i.e., where the insurance company agrees to cut their claim by anywhere from 25% to 50%, or possibly more, depending on liability/collectability issues. Good luck.
    Answer Applies to: Tennessee
    Replied: 5/14/2013
    Andrew T. Velonis, P.C.
    Andrew T. Velonis, P.C. | Andrew Velonis
    When you state that you are "receiving a settlement in a personal injury lawsuit" I hope that means that you have a lawyer representing you. That's who you should ask. There is a great deal of inconsistency in this area. For example, if it is a worker's compensation policy that paid your benefits, then you have to pay them back. If it is no-fault, you don't. If it is a program funded by Medicare, you do. If you are covered by Social Security and Medicaid paid the bills, then you usually don't. If it is private insurance, they can't make you repay it, unless there is a clause in their policy that provides for that contingency. The answer could also depend on what state you live in.
    Answer Applies to: New York
    Replied: 5/13/2013
    Gates' Law, PLLC | Thomas E. Gates
    Wants you accept a settlement, you will have to pay the insurance company back before you will see any of the proceeds.
    Answer Applies to: Washington
    Replied: 5/13/2013
    The Law Office of Stephen R. Chesley, LLC
    The Law Office of Stephen R. Chesley, LLC | Stephen R. Chesley
    If a private insurance company pays your medical bills and you have a personal injury action the health insurance company may seek that repayment of some of the bills or percentage. Furthermore, worker's compensation, medicare also require repayment.
    Answer Applies to: New York
    Replied: 5/13/2013
    The Law Office of Harry E. Hudson, Jr.
    The Law Office of Harry E. Hudson, Jr. | Harry E. Hudson, Jr.
    This is one of those cases.
    Answer Applies to: California
    Replied: 5/13/2013
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