VA-subrogation?

[mhb22079]

What is the name of your state? Virginia

Can anyone give a definative answer on whether subrogation applies in Virginia? My wife was rear-ended and we've just used our normal healthcare plan (hmo-Optimum Choice) for doctor's visits. Should a settlement occur can they request part of it to cover thier costs?

Thank You!

[ecmst12]

Why didn't you use your auto insurance?

[moburkes]

Originally Posted by ecmst12

Why didn't you use your auto insurance?

Great advice! Wow that was an EASY one. But anyway, they SHOULD subrogate. There is no reason why YOU should get reimbursed for medical bills that your health insurance paid. THEY should get reimbursed. DUH!

[ecmst12]

It wasn't advice, it was a question. I used to work for health insurance and it was a HUGE pain in the you-know-what whenever we paid claims that should have been paid by auto. They are going to want to subrogate whether you get a settlement or not, it's just a question of whether they seek reimbursement from your auto insurance or from your injury settlement.

[moburkes]

Originally Posted by ecmst12

It wasn't advice, it was a question. I used to work for health insurance and it was a HUGE pain in the you-know-what whenever we paid claims that should have been paid by auto. They are going to want to subrogate whether you get a settlement or not, it's just a question of whether they seek reimbursement from your auto insurance or from your injury settlement.

Okay, you're right, you formed it as a question, but it WAS still good advice. The statement above sorta explains why.

People are not supposed to be able to get coverage in 2 different places. Either health insurance OR auto insurance, but not both. Therefore, when the auto insurance pays the claim, the health insurance will look for reimbursement because they are not required to pay for auto-related injuries. If that was the case, and everyone had health insurance, there would be no need for liability coverage on auto policies.

[mhb22079]

My question dealt with Virginia law and the rights of subrogation, not the topic in general. While I agree it appears to be "double payment" a lawyer I spoke with briefly noted that in some states subrogation is illegal and Virginia is one of them except in certain circumstances that he didn't elaborate on.

The specific statute in question is: 38.2-3405 "http://leg1.state.va.us/cgi-bin/legp504.exe?000+cod+38.2-3405." Obviously we'd like to settle for a fair amount but given that her injuries might require care above and beyond a settlement there is concern about whether addition care would be covered or whether they would continue to draw above and beyond what was settled for in terms of healthcare costs. Furthermore, hiring a lawyer at 1/3 to sort it out could end up costing us money since no doubt the 1/3 would also come off the healthcare.

In short I was hoping someone knew how Virginia law views Subrogation with regards to employer sponsored HMOs and not the morale principles behind it.

Thank You

[moburkes]

An experienced personal injury lawyer must review the health insurance policy as some policies not written in Virginia are not bound by Virginia's anti-subrogation law on this point, but instead are governed under a federal law called ERISA

[mhb22079]

I see, is there anything I can look for in the policy itself that would say whether it is or is not?

As I mentioned I'm affraid that hiring an attorney will take 1/3 of a settlement and if that settlement only covers only slightly over the cost of medical than 1/3 would end up meaning we would owe money.

[ecmst12]

Here is the advice - if you'd sent the medical claims to your auto insurance in the first place, instead of your health insurance, you wouldn't have to worry about any of this.

[moburkes]

Originally Posted by ecmst12

Here is the advice - if you'd sent the medical claims to your auto insurance in the first place, instead of your health insurance, you wouldn't have to worry about any of this.

But he didn't want to. He wants to take advantage of the anti-subrogation law, and potentially get paid 2x for the same medical bills (once for the payment that his health insurance paid and once from the at-fault party).

[mhb22079]

No, that is not the case at all and nor is this about a big settlement. This is the first time my family has ever had anything like this happen and when taken to the hospital we are asked "who is your insurance company" we answer with the same insurance company I have used for 10 years and have followed up as we have any time we have been referred to a physician. Prior to this I've never heard of Subrogation and only learned of it when seeing posts regarding how claims are handled. I only want to ensure my wife gets a fair settlement within the bounds of the law. I don't trust attorneys but am at a loss in understanding this process. I do not want to be surprised by a bill from my healthcare provider and want to make sure I have as much knowledge at my disposal as possible.

I appreciate the "helpful" responses and take issue with the ones that insinuate that my family views this as a payday. I suggest you evaluate all of the facts before passing judgment. What I requested were the facts surrounding Virginia law so that I could understand the process. A forum such as this should (and in many cases does seem to) provide useful information for those who are unclear about how the claims process works. There is no doubt based on what I've read that insurance companies are not out to help consumers and are not apt to offer fair settlement if they don't have to. I hoped that I could get a simple answer to a simple question but it seems that some feel the need to question the motives of questions posted here.

[moburkes]

Originally Posted by mhb22079

I don't trust attorneys but

There goes the end of your advice. Have a good day.

Here is one sure thing...due to the amount of $$$ you are looking to get out of this, if you don't get a PI attorney involved, you can count on getting VERY LITTLE if anything from the insurance company.

33% of something is better than 0% of nothing.