by Guest » Tue Jun 03, 2008 10:00 am
My ins company paid my medical bills through my med pay. The accident was NOT my fault. The other ins company told me that they would reimburse me the $5000 med pay that my company covered. They are telling me now that they do not pay the med pay back to me. Whats up with this?
Posted: Wed Sep 15, 2010 08:06 pm Post Subject:
Do I have an recourse?
For what? Your carrier (Auto Club), paid a claim to you. Then the other party's insurer paid the same claim to you. You have been paid 200% for your loss. You are only entitled to 100%. So the excess has to be paid back to your insurer.
The concept is call SUBROGATION. It's discussed in your contract. If you haven't read that section, I recommend that you do.
Posted: Tue Nov 02, 2010 04:20 am Post Subject: Auto Accident
I was in an accident that involved a girl hitting me as she tried to make a turn. My vehicle damages were 1300 and my medical were approx 8000. My medpay has covered the 5000 (limit) and I am in Missouri. Is that MedPay going to be refunded back to me directly or will I have to pay back my insurence company? Please let me know. Thank You!
Posted: Mon Nov 08, 2010 05:30 am Post Subject:
My medpay has covered the 5000 (limit) and I am in Missouri. Is that MedPay going to be refunded back to me directly or will I have to pay back my insurence company?
Refunded? Do you mean if you receive a payment from the other party's insurance for the same loss already paid for by your auto and/or health insurance company do you get to keep the money?
The answer to that is NO.
How were your $8000 in medical bills initially paid? By your medical insurance? If you also received $5000 from your auto insurance MED PAY coverage, guess what? You owe THAT MONEY to your health insurance company.
And if you collect $8000 from the at-fault party (or their insurance company) for your medical expenses, you'll still owe your health insurance company $3000 ($5000+$3000=$8000).
The concept is called SUBROGATION. Your medical insurance is for FIRST PARTY (those you experience/cause yourself) losses not covered by other insurance (that of a third party, as in the person who caused your injuries.). Your auto insurance MED PAY is, in most states, considered EXCESS coverage -- it pays claims not paid by other insurance (yours or another party's).
Your auto med pay should only have paid for damages not paid for by any other insurance. Your medical expenses are rightfully those of the party that caused your injuries. Anything you collect from them for those losses must rightfully be reimbursed to (up to 100% of the amount paid by) your health insurance company.
At this point, if you think of your medical expenses as having been paid by you, you've paid about $8000. You've been "reimbursed" $8000 by your health insurance company, $5000 by your auto insurance company, and may be reimbursed another $8000 by the at fault party's auto insurance company. In other words, you paid $8000 and collected $21,000, giving you a $13,000 net gain. See anything wrong with that?
Insurance is supposed to INDEMNIFY you -- restore you to whole. It is not intended to provide a profit. These payments for your medical expenses are known as "special" or "specific" damages" -- acutal, verifiable amounts of "loss".
Receiving compensation for "pain and suffering" is entirely different. That is known as "general" damages. That is entirely "intangible" -- whatever you agree to or a jury awards. It does not provide a "profit" because you are assumed to have "lost" at least that much in value. May apply in your situation, but must be identified separately. You cannot consider payments for your medical expenses that exceed those expenses your compensation for pain and suffering, and keep the money under that pretense.
The last form of damages for which you may receive compensation is known as "punitive" -- punishment of a party with liability who acted in bad faith when it comes to handling the claim (in addition to their negligence). Punitive damages are intended to "discourage" that party and others like them from acting in the same manner in the future. Probably doesn't apply in your situation.
Hope this helps.
Posted: Thu Nov 18, 2010 10:37 pm Post Subject: MedPay Confusion Continued
Well, my health insurence didnt pay anything.
My MedPay from my Car Insurence is who paid the $5000.
I still have outstanding bills of approx $3000.
When the at fault party reissues money to me, do I need to pay that 5000 back to the Car Insurence Company even though I was paying initially for the extra medical coverage?
And, since I now have a "pre-existing" neck injury because of the car wreck- how would you suggest I bring this up to the at fault insurence company? Would it be classified as pain and suffering or something different??
I really thank you for your time- I am a 20yr orphan who has no idea what to do. I just want to do what is legally right and as you said, Im not trying to "make a profit" 4 lawyers have turned down the case. God Bless.
Posted: Fri Nov 19, 2010 03:09 am Post Subject:
Your MedPay coverage may or may not be subrogated -- it depends on your state's law. Normally it is considered excess coverage, meaning it pays what other insurance does not pay.
If you are reimbursed for only the remaining $3000 in unpaid medical expenses, it will not be subrogated under any circumstances. But if you are reimbursed for all $8,000, then you may have to repay your auto insurance company.
Beyond your specific damages (medical bills, lost wages, any other "economic" losses -- to your vehicle, etc), then you have the non-economic or "general" damages such as pain and suffering.
If lawyers are turning down your case, it is a sign that there is not much to sue for. So you may only be looking at a couple of thousand dollars for your neck injury above medical expenses.
Your neck injury is not "pre-existing" in relation to the at-fault party's insurance -- it is the direct result of that person's negligence. It would be preexisting to any new health or disability income insurance you might consider applying for.
If that results in a "substandard" rating, it would be the basis for additional "specific" damages, not general damages.
Posted: Mon Nov 22, 2010 06:24 pm Post Subject: Thank you for your advice!
Thank you again for your help.
Posted: Sat Nov 27, 2010 04:56 pm Post Subject:
If you are reimbursed for only the remaining $3000 in unpaid medical expenses, it will not be subrogated under any circumstances. But if you are reimbursed for all $8,000, then you may have to repay your auto insurance company.
Being a Missouri policy holder who also has been involved in accidents where my med pay covered my injuries or xrays, the money that was paid through medpay can not be deducted from the at fault party's obligation to pay for the negligence of their insured under their liability. My company can not subrogate to recover any medpay and I am under no obligation to pay my insurer back any settlement received where the medpay amount was included.
Some might consider this enrichment but Missouri does not look at it in that matter even though it appears as if one is double dipping. For this reason I carry 25,000 in med pay. It's inexpensive insurance and I do not have to be in any hurry at all to cover my medical expenses in the event the other party is at fault.
Posted: Sat Nov 27, 2010 11:45 pm Post Subject:
It pays to get injured in the right state with the right coverage!
It's a lose - win situation. Life is usually better if you don't suffer any injuries.
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