When a person gets injured, the last thing they are thinking about is how the various insurances interplay with one another. The first thing that should always be focused on is getting the necessary medical treatment. At our firm, we have a textured knowledge of insurance law and how each policy affects the other and we can unwind the confusing mess that a personal injury claim becomes. This allows our clients to focus on the treatment they are receiving, while we focus on getting the right insurance to pay for our client’s medical bills.
There are three basic sources for payment of medical bills. The first is obvious, and it the health insurance for our clients. The second is no-fault coverage, and not everyone is aware that this provision in your automobile policy covers medical bills from an accident. This takes the form of “medical payments coverage” in New Hampshire, and “personal injury protection (PIP)” in Massachusetts. Our attorneys are very familiar with both types of insurance and can help utilize these sources to reduce your obligations at the end of the case.
If your health insurance pays bills, then the health insurer has a right of recovery against our client’s settlement or judgment called a “subrogation” right. Often, the health insurer will send our office a notice requesting a lien on the file. This is due to the fact that a person injured in an accident is not allowed to get a “double recovery”. This would be where health insurance pays a bill, and then the client takes a settlement that includes compensation for those bills but does not pay the health insurer back. This right of subrogation by a health insurer is a contractual right included in the health insurance policy. Accordingly, it almost always must be paid back.
If a client has Medicare, Medicaid, or Tricare (a/k/a “military”) insurance, then each has a statutory right to be paid back from a settlement or judgment our clients secure. This is based on the same “double recovery” principle, except the rules are much stricter and coordination of benefits becomes very important. Medicare, especially, can create significant delays in resolving these subrogation liens, so it is always important to talk to an attorney about your rights in your case.
There are other forms of liens in Massachusetts, including statutory hospital liens. In all cases, the interplay of the various insurances involved become very important to coordinate. For example, the medical payment coverage referenced above does not include any subrogation rights. This means that if your medical payment portion of your policy pays a bill, then they cannot recover that payment from the settlement or judgment. Thus, it becomes very important to find an attorney with a detailed knowledge of the insurance rules and how liens on injury files work.