Health Insurance Reimbursement After a Car Accident Injury Settlement

The least you should know…

• Often, your health insurance provider will pay for injuries suffered during a car accident
• The actual party responsible for your injuries may be your own car insurance company or the other driver’s auto insurer
• When this happens, your medical insurance company is entitled to sue on your behalf to be reimbursed for their costs in providing your medical care

After a car accident that involves injuries, your health insurance may pay your medical expenses even though the other driver’s car insurance should cover those costs. So how does health insurance reimbursement after a car accident work?

The auto insurance claims process can take a long time, and most injuries require immediate attention. If you can’t wait for payments from an insurance settlement to pay for required medical care, your health insurance company will generally pay for the care you need as a result of your injury.

If there’s a dispute regarding how medical bills are paid after your car accident, you may need to consult with an experienced insurance attorney. You can enter your ZIP code int our search tool to start your search for an insurance lawyer.

How are medical bills paid after a car accident?

If you paid for your own medical care out-of-pocket, then you would be reimbursed at a later date when the settlement is finalized because medical bills are generally part of damages awarded as one type of car accident compensation.

When someone else pays, it is only fair that they too are paid back for what they spent. In most cases, your health insurance company will be reimbursed from a car accident settlement.

This is through subrogation. Subrogation rights are the rights a company has to sue whoever owes you for damages that the company actually paid for. The rationale behind this is that since the health insurer paid for your medical treatment, it is entitled to get the money back from the settlement (just as you are entitled to reimbursement for your expenses, like lost wages).

This is true with private or public insurance; if your bills were covered by Medicare or Medicaid, accident reimbursement is appropriate.

Reimbursement and Attorney’s Fees

It is important to note, however, that depending on the laws in your state and the terms of your agreement, the health insurance company may get a reduced reimbursement due to attorney’s fees.

For example, if your lawyer charged 33% of the settlement, and the health insurance company is entitled to $1,000 in reimbursements, it may receive $666 instead. The rationale in those cases is that the health insurance company must pay its fair share of the car accident lawyer’s negotiated fees.

Frequently Asked Questions: Health Insurance Reimbursement Plans after an Auto Accident

How do you negotiate with insurance after an accident?

Though it may be the last thing you want to do after an auto accident, you may have the opportunity to negotiate with your medical provider, your health insurance, and the auto insurance of whoever was at fault for the accident.

The best preparation for negotiating your car accident insurance settlement is to know the details of your policy. It may be necessary to have the help of an insurance attorney, though. This is especially true if your auto or health insurance won’t cover the car accident at all.

After you agree to a settlement, you will be unable to continue negotiating medical bills after the settlement, so be sure to account for all current and anticipated future bills before you agree.

Can my health insurance company take part of my settlement?

When your health insurance car accident settlement is finally reached, your insurer will be entitled to any amount that they paid for your care that was determined to be the responsibility of someone else. This may be limited by the fees charged by attorneys, but it is not uncommon.

The rationale for this, as discussed above, is that even though the settlement is awarded to you, the treatment you are being reimbursed for would have been paid by the health insurance company rather than out of your pocket.

Who pays first, auto insurance, or health insurance?

There are a variety of factors that dictate which insurance company pays first: whether it’s your car insurance or the other driver’s, the relationship of the care provider to your health care insurer, state law, and company policies. Car accident insurance medical claims will, however, typically not be paid as quickly as health insurance medical claims.

This is primarily because medical insurance companies are more likely to have relationships with healthcare providers. It is also often the case that you have a relationship with your own healthcare insurance company, but do not have one with the other driver’s auto insurance provider.

Where to Find Other Answers

The details regarding contingency fees, your insurance company’s coverage policies, and anything else you may need to know about such rules or regulations should be contained within your insurance contract.

Speaking to an agent will also be essential so that you know exactly how things stand and when payment will be made. You should also remember that even if your insurance company is liable for your medical treatment if they are waiting on a settlement and don’t pay, the medical facility can end up billing you instead.

This can cause complications on your credit, so it is best to know what to expect before the process begins, if possible. Read your insurance paperwork carefully and call them with any questions or concerns.

You may also wish to contact an attorney to find out exactly how the car accident settlement process and health insurance reimbursement will work based on your situation.

Some states have specific laws related to health insurance companies and car accident settlements, your attorney will be able to provide you with information specific to your case. To search for an insurance lawyer, enter your ZIP code in our search tool below.

Case Studies: Health Insurance Reimbursement After a Car Accident Injury Settlement

Case Study 1: John’s Experience With Health Insurance Reimbursement

John was involved in a car accident that resulted in injuries requiring immediate medical attention. Although the other driver’s car insurance should have covered his medical expenses, the claims process was taking a long time.

In the meantime, John’s health insurance company stepped in and paid for his necessary medical care. Eventually, when the settlement was finalized, John’s health insurance company sought reimbursement from the car accident settlement.

Case Study 2: Maria’s Medicare Reimbursement

Maria, a Medicare beneficiary, also faced a similar situation after a car accident. Her medical bills were covered by Medicare, but she still had to go through the process of a car accident settlement. In the end, Medicare sought reimbursement from the settlement to recover the costs they had paid for her medical treatment.

Case Study 3: Reduced Reimbursement Due to Attorney’s Fees

Sarah, involved in a car accident, had her medical expenses covered by health insurance. Upon settlement, her health insurance company sought reimbursement. However, with attorney’s fees set at 33% of the $10,000 settlement, the health insurance company received a reduced reimbursement of $666 instead of the full $1,000 they were entitled to, ensuring a fair distribution of funds.

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