HC Subrogation / ERISA

[JoBarry]

Arizona.

If I was injured in an auto accident and my health care plan (through my employer) paid part of the medical bills are they entitled to subrogate against any future settlement I may receive? Bear in mind the amount they paid is about $1,600 - the portion I owe that was not covered is around $2,000. Is there a certain $$ amount that needs to be reached before an insurance carrier would pursue this? (in other words not worth their time/$ to go after this amount). Also, I've heard about ERISA but do not understand how/if it would fit in this situation. Thanks in advance, Joanna.

 

[ALawyer]

If you were injured and incurred that level of medical bills, I hope you see/saw a lawyer about a possible personal injury claim.

Your health insurer is entitled to subrogation. Each carrier has its own limits as to when it "pays" to go after the wrongdoer, but you can expect they will ask about what you have done.

Generally they ask about what you have done to collect against the wrongdoer. (They normally won't sue on your behalf -- at last at that level -- if you don't pursue it.)

If you have counsel s/he will handle that for you as they should not take the first dollar and leave you with the entire deductible.

 

[JoBarry]

Thanks for the information. In regard to a lawyer, yes I have retained counsel, however I picked one of those "discount" firms and they don't seem too eager to go beyond simply getting their cut. My med bills came to $3,600, my car was totalled, and this firm wants me to see if other party's insurance will offer $7,000 as a settlement.............this does not seem right to me. If you get a chance check out my past posts (12/01) on the Accident - auto message board and see if you have any feedback. No one else responded to me so I gave up there.

Hopefully my healthcare providor won't go after that amount and I can pay my portion only out of any future settlement and be done with it.

Thanks ALawyer for taking time to respond! Joanna.

 

[ALawyer]

I don't have time to go back and read posts but if there is any permanent injury or disfigurement or condition that will limit income or life's activities in any way (that's what BIG money is paid for) or any loss on income or other type of expense incurred, getting less than twice the medicals also is clearly inadequate, especially after the lawyer's share.

It is lots more lucrative for an attorney, in terms of hourly income at least, to get 25% of a quick $7000 settlement (that's $1750) with 3 hours of work ($583 per hour) than to develop the case, negotiate hard, and if needed file suit, which might take 15 hours and require filing fees of $500 and only get a $10,500 settlement in a year after some more back and forth and getting on the court docket , but after repayment of the $500 turns into only $166 per hour. And if the case really is only worth a maximum of $10k spending the extra time really is not worth it for the lawyer.

But as you said, you picked a discount lawyer mill. Such operations take as many cases as possible in the front door and settle them out as quickly as possible. And many clients want something fast so sometimes they are happy to get a little money quickly rather than a lot more later on -- especially if they have bills to pay.

The good news is you have the right to change lawyers. My suggection is that you consult another lawyer. If the other lawyer takes the case he winds up splitting the fees with the old lawyer, bu tyou may get something much greater than the guy is asking you to hope for.

 

[JoBarry]

Once again, thanks ALawyer for your feedback. I don't feel my injury will result in permanent disability, but I will never be 100%. I know I will always have the occasional backache, but hey, just like if your car gets damaged and you get it repaired...... it looks the same but it will never be the car it was.

As for changing attorneys, the attorney in my office building has been giving me some free advice. Also, he told me if I was not satisfied w/my attorney (ie; they refuse to pursue or take to court) that I could ask them to resign as my counsel and give up their fee vs. "firing" them and still owing $$. Do you see these "lawyer mills" (as you so appropriately called them) doing this if asked???

I promise this will be my LAST question of you!! Thanks, JO.