Is My Health Insurance Company Entitled to Part of My Personal Injury Settlement?

Is My Health Insurance Company Entitled to Part of My Personal Injury Settlement?

Couple Reading Letter In Respect Of Wife's Neck Injury

February 21, 2017

Ellis Law Corporation

Personal Injury

When you settle a personal injury claim, you might not be entitled to keep as much as you are expecting – the entities that paid for part of your medical bills, including the health insurance company and Medicare, can require reimbursement. An experienced personal injury lawyer like the attorneys at Ellis Injury Law will account for this and help you obtain maximum compensation to fully compensate for your injuries.

Health insurance company right of subrogation

Insurance is a special type of contract and one of the terms in most contracts for health insurance is what is known as a lien subrogation right.

The insurance company’s lien subrogation right applies in very specific situations. If your injury is caused by someone else and you recover for your medical bills from a third party, your insurance company is often entitled under the policy terms to be reimbursed for the amount it paid for those same bills related to that injury.

Unfortunately this right of subrogation catches many injury victims off-guard. They agree to a personal injury settlement assuming that the amount will be available for their ongoing expenses, but instead it may go to the insurance company.

Be aware of Medicare liens

Even more tricky is a lien by Medicare, Medicaid (or Medi-Cal) or the Veteran’s Administration. When these government entities have paid for any of an injury victim’s treatment that may have been caused by the third party, they also have a right of subrogation.

Handling a Medicare lien, for example, in a personal injury case is fact-intensive and, at times, tedious. It is important to double check all Medicare charges identified to ensure that they were indeed related to the personal injury. It is also important to follow the status closely and if the lien is not paid it can lead to penalties and interest. Veteran’s benefits, however, have higher priorities under federal law and must be paid before the other liens.

Benefits of a Los Angeles personal injury lawyer

It may be clear that coordinating medical subrogation liens can take some juggling and this is one area where an experienced lawyer is indispensable.

Most people are unaware of the effect that the subrogation lien can have on their settlement, but a dedicated injury attorney will take these into account. Experienced Los Angeles personal injury lawyers also have the skills necessary to involve the insurance companies and Medicare representatives in the settlement talks and potentially negotiate a lower lien payment, preserving a greater amount of settlement proceeds for the victim.

The committed and compassionate personal injury attorneys at the Ellis Law Firm are determined to make sure clients are fully compensated for their injuries. This often means negotiating with insurance companies and other medical lien claimants to make sure the injury victim’s rights are protected. If you have been injured and believe someone else is at fault, contact a representative at the Ellis Injury Law Firm for a free consultation.

Additional Medical Subrogation Resources

  1., Reimbursing Medicare: Medicare’s Demand Letter,
  2. CMS.gove, Coordination of Benefits & Recovery Overview,
  3. California Department of Health Care Services, Personal Injury Program,