What is Subrogation?
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- Опубликовано: 26 сен 2024
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If you have a personal injury settlement, you may not always get to keep the money you are awarded. In addition to medical provider liens, which we discuss in another video ( • What is a Lien? ), you also need to be aware of something called "subrogation interests," which is a way your health insurance company may take money out of your pocket.
In this video, David Henson of HensonFuerst Law firm talks about subrogation: What it is, what it means for your settlement dollars, and how a lawyer can help you navigate the complex state and federal laws that come into play.
(This video contains a dramatization and does not depict actual events or real persons.)
** Principal Office of Henson & Fuerst, PA: 2501 Blue Ridge Road, Raleigh, NC 27607 **
Hi, this is David Henson from HensonFuerst Personal Injury Attorneys. In another video, I spoke about liens, and how they can reduce the amount of money that you end up with after a settlement for your personal injury claim. In addition to those medical provider liens, you also need to be aware of what are called SUBROGATION INTERESTS, which are claims that may be made by your health insurance company.
If you think the word "subrogation" sounds scary, you're not alone. And unfortunately, subrogation IS scary. Essentially, subrogation means that your health insurance company can make a claim to get repaid for medical bills that they paid on your behalf. If the claim is valid, it can dramatically eat into your portion of settlement dollars. Got that? Your health insurance company...which collects premiums from you year after year with the promise of paying for your medical bills if you get sick or injured...puts in a claim to back your medical bill payments. Does that sound fair to you? Well, it shouldn't, because it is unfair, and some people believe it is even unethical.
Before I describe how this works, let's take a quick trip back to civics class for a refresher on the difference between state laws and federal laws. STATE LAWS apply only to a single state. For example, North Carolina state laws only apply to people who live in North Carolina. Federal laws, however, apply to all 50 states in the country. Federal laws ALWAYS trump state laws, which mean that if a state law and a federal law are in conflict, then the federal law wins out.
So, back to subrogation. North Carolina has state laws which say that a health insurance company CANNOT make a claim for reimbursement out of your personal injury settlement. This means that if they pay $1,000 on your hospital bill, then when you settle your case, they have no right to get repaid for that amount. You get to keep it.
Federal law, however, says that if a health insurance company jumps through certain paperwork hoops, then they can collect repayment for your medical bills, with no cap on the amount. I have seen cases where the health insurance company made a claim for ALL of a client's personal injury settlement dollars, which meant that the client was left with nothing.
Now...what determines whether a health insurance plan is controlled by state or federal law? It's complicated, and that's why having an experienced lawyer on your side can make all the difference. A personal injury lawyer's job is to carefully analyze the guts of the health insurance plan to see if they have a right to repayment, and to make sure that they have jumped through all the appropriate hoops. If not, then state law kicks in, and in North Carolina, state law says the health insurance company has no right to repayment. On the other hand, if the claim holds, then a good lawyer will fight to help you keep every possible dollar. Many times, we can negotiate the repayment down to a fraction of the original claim, which means more money staying in YOUR pocket.
Subrogation is a highly technical issue. If your injury case involves substantial medical bills (and health insurance payments on those bills), then I STRONGLY encourage you to talk with an experienced lawyer. It could make a huge difference in the amount of money you are able to preserve out of your personal injury settlement.
Again, I'm David Henson, managing partner with HensonFuerst. If you have additional questions, go to our website at www.lawmed.com, or you can email me directly at dhenson@lawmed.com. If you have questions, HensonFuerst has answers.
I am 64 and I just herd this term from a claims rep regarding damage to my house from a water main break.
Can't you just sue for medical costs plus your settlement would that solve the problem?
Please explain that a self funded ERISA plan is fully funded by the premiums that the employees pay monthly. The premiums go to a trust that is deducted from, when anyone in the plan goes to the doctor the payment comes from that trust . If there is a third party liability that is 40k that creates a huge gap in that trust that your client and everyone in the employee group has to make that up with the increase of premiums the following year.
Subrogation can also be used in any court case where no one was injured or harmed such as traffic violations, or mortgage foreclosure..
And where did you get that idea?
@@chslaw From the laws I have read and comprehend.. You should try reading and comprehending ast least understanding the U.C.C. laws that even STATE COURTS must follow under the Constitutions' "Supreme Law Of The Land"..
@@1realestatehomes You might as well have just told me to Google it, which still would have been useless advice. I am familiar with the UCC laws and plenty of other laws. Whenever I see someone claiming subrogation can be used to file traffic violations or mortgage claims, I usually encounter nonsense. If I ask for proof, I still get nonsense.
So please do not waste my time with the "research it for yourself" nonsense. That usually takes me to some sov cit website for video where someone erroneously claims that all crimes are commercial or falsely claiming that you don't need a license to drive unless engaging in commerce.
You claim to have read laws...okay, what laws do you believe support your contentions? Because there is absolutely nothing in the UCC the even remotely says subrogation can be used in traffic violation cases or to stop mortgage foreclosure.
@@chslaw So you are an ATTORNEY or in Law School where you have never heard of BLACKS LAW DICTIONARY either, Rigt??
@@1realestatehomes I never have understood why some people have such a fascination with Blacks Law Dictionary. Yeah, I am familiar with it. So what? It is useful as a tool for people with out a legal background to learn a little bit background on legal terms.
If fact, Blacks Law Dictionary is wrong form time to time or has changed. For example, sovereign citizens loved to point out that the definition of driver that appears in the Second edition of BLD that came out on 1910, probably because it is available online for free. Well, the 2019 edition of BLD has 3 definitions for driver: "1. Someone who steers and propels a vehicle. 2. Someone who herds animals; a drover. 3. A piece of software that allows a computer to work with another piece of hardware such as a mouse or a printer.”
No version of BLD is a binding source of law, and I certainly woudn't use a version that is 110 years old.
Now back to my question that you overlooked. What laws do you believe support your contentions?
Healthcare insurance covers health care issues. It does not provide coverage in the case of an auto accident. Therefore, the auto insurance company is responsible for personal injury sustained in an auto accident. Your healthcare insurance company will probably pay your bills until your case is settled. The healthcare insurance company has a right to reimbursement if the auto insurance of the at fault party is responsible for the damages.
Michael Davis,
Hi Mr. Davis, is that a state by state or is that a Nationwide policy right of all health insurers?? Which may answer why the patient was left with nothing, ( if he was "at fault" ).
I know it is the law in California but I can not say for certain it is the law in other states. However, I would imagine it is uniform through out the country.
Makes sense however are they going to be fair in how they bill you. If they see that you win your case for 2 million will they just trump up the bill to that much. This is where it gets sticky and completely unfair.
i got a subrogation notice from a collections agency that they want to collect money on behalf off allstate my brother was driving my car and he was uninsured, however i do have insurance on the vehicle and he got into a car accident he said he was not at fault no police report any advice ?????
Just asking... Doesn't the 10th amendment say that state law trumps federal law. It's my understanding that only supreme court rulings are the only thing that can trump state law.
No.
Carl Starrett
Then how are states able to legalize pot?
reason.com/blog/2013/04/16/states-can-legalize-marijuana-though-fed
Because attorneys are bipolar between law and legalese. It's like comparing physics to fantasy. Legalese is the realm of unicorns poopin caramel popcorn biscuits. Physics is the factual horse that shits.
OK. Here's a question that ought to be simple, but I'm finding nothing:
Regarding a local criminal case here in Kanawha County WV, how would I find the progress?
Is there an online source? Can I simply visit the courthouse or county prosecutor's office?
It seems these things should be a matter of public record(?)
Any help would be highly appreciated.
You need to "frequently" visit the Clerk of Court and ask for the information concerning your case (the docket). Lawyers/judges are notorious for making "last minute changes" which can adversely affect you! The Judiciary and State Attorneys -- for the most part -- are sneaky and corrupt! They bite and kick and cheat at every opportunity!
Daniel Baggett -- thanks so much for the reply.
Sounds like you've gotten the shaft by the people with power -- real power.
I've seen these people in action, and the results.
Hope you were able to navigate the system for a just outcome.
This case is actually that of "a friend" of sorts.
He's charged with multiple counts of a sexual nature -- involving two children.
He's an ex-cop, and knows the law pretty well, and I struggle to get my brain around it.
He was arrested in April of '17, and spent several months in jail before making bail and home-confinement.
He's made contact with me, and I just don't reply. He's had his daughter ask me to come to visit him. I just can't do it.
I have little doubt he'd concoct some story -- either minimizing his actions or claiming a frame-up. He's just that kind of guy.
Nonetheless, I'd like to get the straight dope on his case, strength of the evidence, progress of the case.
The arrest was by the Sheriff's Dept. Do I contact the County Clerk of Courts? Best to go in person?
Again, thanks for your response.
Mike
The problem with your position is that at least potentially it ends up giving a windfall to the insured party by his getting compensated twice for one injury.
If you look on insurance not as a gamble but as an assurance that an adverse event will not harm the insured financially, then an insurer is only obligated to make the injured party whole, not to pay them so they are better off than if they had not been injured. Concomitantly, the objective of a lawsuit is to pay damages, not to contribute to making a person better off. If a judgment is awarded, or there is a settlement in respect of medical bills, and then the insurer also pays for those same bills, that is unfair. If an award is made only in respect of expenses uncompensated by insurance, then subrogation would be unfair. But it is unfair if the award and the insurance are for the same expense and subrogation is prohibited. You should be clear about that.
Always Pre read the entire policy document prior to signing or making a payment or ask the insurance seller to read you out their terms to subrogation never mind most dont even know the meaning to the word
Amazing.....
? Is subrogation Relative to traffic citations & a good defense?
robert burke * absolutely !
No. They are completely unrelated.
@@chslaw you don't have a clue
@@sammyd7857 So how long have you been an attorney?
@@chslaw more to the point, you made the first statement so how about you??
DIDN'T KNOW THAT,,,thanks
Sounds like capitalism at its finest.
unfortunately, that didn't explain the mechanism of how or why subrogation works... just that Fed laws override State laws... without mentioning when there are even exceptions to that! i.e. I don't feel 100% sure that even that principle is 100% absolute...
sigma six He did explain subro at the beginning - he stated it's when an insurance company seeks reimbursement. It is usually from a liable party. Another example is when a medicaid or medicare recipient dies and the state wants their estate or property to sell for reimbursement.
Separation of Powers doctrine...Federal law does not trump state law because the states are separate sovereigns irrespective of the federal government. State laws are trumped in cases of constitutionality then can a federal law more catered to the constitution relevant to the state law trump that particular state law.
Incorrect. There are plenty of areas where the Constitution gives the federal government primary or exclusive jurisdiction. Per Article VI, Paragraph 2: "This Constitution, and the Laws of the United States which shall be made in Pursuance thereof; and all Treaties made, or which shall be made, under the Authority of the United States, shall be the supreme Law of the Land; and the Judges in every State shall be bound thereby, any Thing in the Constitution or Laws of any State to the Contrary notwithstanding."
The 10th Amendment curbs that somewhat, but there are plenty of area where federal law trumps state law.
Your references to separation of powers doesn't make any sense.
@@chslaw I'll give you an opportunity and time to delete your comment before I return with the laws that expose your ignorance. If not, then just wait right here and leave your comment suspended so that I can show you through law, just how ignorant you are.
@@whathuh6965 By all means, please proceed.
@@chslaw It's obvious you're ignorant to the legal term, "Checks and balances", hence the reason why I mentioned the "Separation of Powers" in my previous message, and it's totally relevant to consummate my initial reasoning. Sit tight young man...
@@whathuh6965 Considering that your post was almost completely wrong, this should be entertaining to look at whatever nonsense you come up with.
Common law beats both of em 👌🏼👍🏼
Yeah, no.
Why not buy your bond using your name? Ta hell with insurance
Say what?
Carl Starrett To be blunt.. Your name is a Title and you make that title equitable by just breathing. Your signature creates a bond with the insurance. Why not just go and buy a bond yourself. You are the surety & grantor (living person/common law) of your estate (name on birth certificate/corporate law)
To be blunt, you are an idiot and have no idea what you are talking about.
Carl Starrett Lol sure I don't. I know the truth Son. This is why I beat court cases and laugh at the notion of a loan with no money giving or signature from the other party. Stay asleep sheep.
Oh really? How about provide some proof of your claims? Case numbers? Court? You sound like one of those sov cit liars that make claims and never back them up.
You're wrong constitutionally. 10th Amendment. You'd better read it again...
What language in the 10th Amendment do you think makes him wrong? And wrong about what?