Health / Auto Insurance subrogation

Posted: Wed Jan 14, 2009 01:35 am Post Subject:

I guess I should not look a gift horse in the mouth right?

Posted: Wed Jan 14, 2009 05:46 pm Post Subject:

Thanks then once the atty sends them the check for the amount they are subrigating this should be over and done with. I guess it is just blowing me away because at one point they said they had not sent a form yet because they were looking into any recent treatment I had gotten since July when they made their first request. I was honest and told them there was additional treatment. (thousands of dollars worth). They never added to the amount they requested. I just figured they would have wanted all they could get.

Posted: Fri Jan 16, 2009 11:18 pm Post Subject:

Remember, if you can not go back to work you can always file for social security disability. You lost your job because of this and I am thinking that it will be hard for you to regain employment in the field that you were in. Any chance for some retraining????

After you get released from your doctor maybe you can look into the office of vocational rehabilitation, they help people who are in your situation who are ready to be retrained back into the work force. The only criteria is that you must be able to work.

Posted: Wed Apr 15, 2009 08:57 pm Post Subject:

DO NOT PAY THEM BACK. All of these people stating you are "required" to pay that $1K back might be technically correct under the terms of the policy - but the plan WILL NOT be able to enforce that claim against you in any way should you simply choose to ignore them. They will send you some threatening letters and so on and so forth - but in the end whatever examiner has that case will simply close the file and you'll never hear anything else about it.

GUARANTEED. DO NOT PAY THE HEALTH CARRIER BACK.

Posted: Thu Apr 16, 2009 09:45 am Post Subject:

He dmart, I fail to see how you can actually avoid paying the required back to the insured if you state actually states that. Some states allow the claimant to retain the money they had received from the third party, which is called double dipping. But in other states the insurer has the right to recover the amount it has paid to their insured. If the insured avoid paying the insurer won’t it affect the relationship between the parties? Would the insurer still renew the policy of the insured?

Posted: Thu Apr 16, 2009 10:37 am Post Subject:

I also can not see how you can avoid paying them. I just went through settleing out a medical claim and they do by law (depending on state) have the full right to recover any monies paid to your care. This comes usually before any money that you would have coming to you. If you read through your policy you will find soemthing in there regarding this issue. The insurance company probaly sent a letter to your health insurance provider that acknowledged sending you this check for med pay.
If it is subratable then you could end up in trouble. Now the only thing they should be able to collect is that amount you recieved for you policy med pay.They can not come after you for any other monies not recovered after that. I would really advise paying this.

Posted: Thu Apr 16, 2009 12:12 pm Post Subject:

dmart1000---pretty powerful statements you've made here...how about backing them up with atleast 'some' documentation, what experience do you have that could possibly give you an ability to 'gaurantee' your statement?

Posted: Thu Apr 16, 2009 01:36 pm Post Subject:

I worked in medical subro for 7 years. There's two reasons I say he should keep the money. 1: The health carrier does not have an ENFORCEABLE claim. 2: Regardless of contract terms, he should keep the money on principle alone. Let me explain....

My understanding of the situation is that this person received a check from his own auto carrier for $1K from his medpay - presumably for medical bills that his health insurer also paid - so it's a pretty clear case of "double dipping" if he keeps the money.

ENFORCEMENT

In reality, the plan has no enforcement mechanism to actually compel him to return the money - other than send various threatening letters...which are empty threats. The money in question is far too small for any litigation to be cost effective so there's no risk of him being hauled into court. Additionally, he's probably part of a group benefit plan so they can't "cancel" or refuse to "renew" his coverage on account of this.

Finally, if he's covered under an ERISA plan he's in even better shape because all he has to do is tell the plan that he spent the money and no longer has it in his possession. An ERISA plan cannot enforce the repayment of funds that are not in the possession of the member (ie: he spent the money) because to do so would be to impose a "legal liability" on the member - instead of an "equitable liability" - which ERISA does not support.

Either way you cut it - his policy may well have language that says he has to pay them - but they cannot and/or will not enforce the claim so he should just keep the money and move on.

PRINCIPLE

I realize this flies in the face of the overall purpose of subrogation, but I've learned enough about how subrogation in the healthcare business really works to know that there isn't anything fair or equitable about how it is done these days. It's not about indemnifying insurers any more. Insurers have turned to the "contract" as a means to get around any and all equitable limits that were intended to protect the victim (injured person). Now, companies use "first dollar" recovery provisions in their policies (which are contracts of adhesion that the member cannot negotiate) which can literally allow a Plan to take 100% of a person's injury settlement, regardless of whether the funds paid fully compensate the victim for their damages or if the funds are even inclusive of medical expenses.

Such claims serve only to increase the profits of the Insurer (or at best offset their own subrogation liabilities or administrative costs) at the expense of the victim. All the while the Insurers are claiming that such recoveries "keep your premiums low" which is a fallacy. There is no relation between subrogation recoveries and health insurance costs - and I challenge anyone to show me empirical evidence to the contrary.

So I say KEEP the money, because the health carrier doesn't deserve it.

Posted: Thu Apr 16, 2009 01:44 pm Post Subject:

The "guest" response above about the medpay belongs to dmart1000 - I just can't figure out how to get the system to allow me to input my user name. It keeps telling me "user name already taken" when I try to reply. Sorry for the confusion.

Posted: Fri Apr 17, 2009 11:18 am Post Subject:

Either way you cut it - his policy may well have language that says he has to pay them - but they cannot and/or will not enforce the claim so he should just keep the money and move on.

So I say KEEP the money, because the health carrier doesn't deserve it