Must I pay back health insurance after a personal injury claim?

Health Insurance pays medical benefits in accordance with a policy that you obtained individually, or through an employer. If you have ever had health insurance, you are undoubtedly familiar with the basic way in which this works: you get sick and see a doctor who examines and treats you. If you’ve met your deductible, health insurance will usually cover most of the resulting medical bill (I won’t get into the intricacies of in-network, out-of-network, co-payments, co-insurance, etc…). The same basic principle applies if you are injured.

Generally speaking (in a non-personal injury claim situation), you do not reimburse your health insurance even though they had to pay your doctor for services rendered (this is the bargain derived from your health-insurance policy – i.e. you pay premiums every month, even if you are not sick. In exchange, the health-insurance company agrees to pay some, most or all of a medical bill that may arise when you do become ill, subject to certain exceptions and limitations).

But, if your injury was caused by the negligence of another, and you make a financial recovery against that negligent party; you will likely have an obligation to, at least partially, reimburse your own health-insurance company.

In a prior personal injury blawg post, entitled: What’s my case worth? I discussed what you are typically able to recover in a successful personal-injury action, which includes medical bills.

In a personal-injury claim situation, your health-insurance policy essentially says: we understand that personal-injury actions can take a long time and you need to see a doctor now. Doctors don’t work for free, so we will pay that doctor (as we normally would in a non-personal-injury-claim-related situation). But, if you make a recovery against whoever caused your injury, we have the right to be reimbursed for that portion of the recovery that takes into account your medical bills.

Otherwise, the insured would get to keep money meant for medical providers even though the medical providers had already been paid. The idea is to prevent the insured/injured party from being overcompensated.

However, your personal injury attorney should utilize a variety of methodologies to ensure you repay as little as possible out of any verdict or settlement. This will be discussed in a future blawg post.

To talk with an aventura personal injury attorney, feel free to call 800.379.TEAM and ask for Jason Neufeld. He can also be emailed directly at jneufeld@nkplaw.com.