Subrogation

I live in MO. I was in an auto accident in MO. The other party was at fault. I experienced neck and back pain that resolved after 8 weeks. The other party's auto-insurance carrier paid for property damages, but refused to pay a settlement for medical and chiropractic bills. My health-insurance company paid the medical bills. I had an attorney examine the case, and also helped me make a claim on my own auto insurance thru the medical payments option. This attorney advised me to not pursue the case because it would likely go to court and I could incur more expenses that it would be worth if I lost. About a year after I stopped pursuing a settlement from the responsible party, the health-insurance company sought subrogation since my own auto-insurance paid me cash benefits based on the value of the medical bills. This attorney has been hard to get ahold of, but he insisted after looking at the health-insurance contract, that I received no recovery or settlements -- just merely cash benefits based on the medical bills, that I wasn't paid "for" the bills. He then wrote a letter asking the subrogation company to close the file. The subrogation company will not quit contacting me and is harrassing me for reimbursement. I don't know who to believe, but I really can't afford to shell out money that someone really isn't entitled to. The health-insurance contract seems to just refer to reimbursement in the case of "settlement" or "recovery" and seems to me the attorney is right, I don't owe them any money.

Could some one tell me how to get the Subrogation company off my back? If I actually had a settlement from the responsible party, I guess I possibly would owe the money back, but since the attorney has advised me and this subrogation company that there is no precedence to recover money based on receiving money under your own medical payments plan. Does the attorney seem to be correct in this matter, and if so, why is the subrogation company threatening to turn me over to their legal department now?

[I AM ALWAYS LIABLE]

My response:

Based upon your explanation in your post, your "attorney" is wrong.

If your medical insurance contract has a "reimburseable" medical provision, then if your medicals are paid by your health care provider insurance, and also paid by your vehicle insurance, then when you obtain payment from your vehicle insurance, you must "reimburse" your health care provider insurance. In other words, you cannot collect and keep double payments against one medical bill.

All because you didn't recover a sum higher than your medical expenses is of no value. Medical providers may assert a lien on claimant's recovery for services rendered in treating claimant's injuries. (Ordinarily, such liens are contractual--i.e., granted expressly by the patient or the plan or policy under which the services are rendered.) [See Kaiser Found. Health Plan, Inc. v. Aguiluz (1996) 47 Cal.App.4th 302, 305-308, 54 Cal.Rptr.2d 665, 666-668; also see Wujcik v. Wujcik (1994) 21 Cal.App.4th 1790, 27 Cal.Rptr.2d 102--medical provider's first-in-time lien has priority over subsequent judgment creditor (Ca Civil § 2897.

Once you receive money for your medical expenses from another (or, third party) source, you then owe the money under the reimbursement agreement.

IAAL