Personal Medical Insurance No Subrogation

[Walcott]

Im in the process of settling my injury claim. I just sent a demand letter. I thought i had to pay back my health insurance but i dont. I already asked for it in my demand letter. Can i just tell them it was a mistake and just deduct it from my demand amount. Will they deny my claim? I dont want to look like a fraud. It was a honest mistake.

[Milbyrne]

Hi Gb,

Quick answer: for now do NOTHING, but learn about the law in your state at the link below.  Here is why: in most states the money is yours since you paid for the health insurance.  

Your question is a side topic of subrogation, and the answer to your problem depends upon the "collateral source rule" of the state you are in.  And that is, as you will see, going to depend upon the extent to which the insurance industry has been able to bribe your legislators with so-called “contributions” to their campaigns.  

At common law, if you made a contract with another insurer(your health insurer) to cover your expenses and with no obligation to pay it back(i.e. no subrogation), the rule is that you keep the money since you paid the cost of insurance to cover your situation and the tortfeasor has the burden to pay for all of his harm.  This is what is called the “collateral source rule”.

If there is no subrogation, you still get to keep the money in auto accident cases(with some exceptions, as noted below).   In most states, if an auto accident victim receives payment for medical bills by a collateral source(i.e. your health insurance), that evidence is NOT ADMISSIBLE to reduce the amount the tortfeasor has to pay.  http://en.wikipedia.org/wiki/Collateral_source_rule

Hence, the money is yours to keep since you paid for the health insurance.

Here is how it works.  The tortfeasor has to pay ALL of the medical bills for treatment and care related to the accident.  If you had no insurance he has to pay 100%.  Why should the tortfeasor get off free from this obligation just because you were wealthy enough and smart enough to purchase your own insurance?

Hence, the payment of medical bills goes into your pocket, and it is rationalized as repayment for your having purchased insurance.  But you might say that it is given free, as part of your job.  Really?  You think that it is free?

NO, your employment package has been negotiated to reduce your hourly or monthly income by the cost of the health insurance, so you DID pay.  As between YOU, who paid for this benefit, and the wrongdoer, who is supposed to pay for his harm done, WHO should get the benefit YOU CONTRACTED FOR?  It seems obvious that the tortfeasor should not benefit on account of what you have purchased in advance to provide for your emergencies.  YOU PAID FOR SOME RIGHTS AND THEY SHOULD BELONG TO YOU AND NOT TO THE INSURANCE INDUSTRY.  Hence, YOU SHOULD GET THE MONEY.

The contrary position has been pushed by the insurance industry in those states susceptible to their influence in the legislature.  No doubt about it, the insurance industry throughout our land has bought the best government money can buy, from the President on down to our state legislators.  Every politician’s mention of so-called “tort reform” and those nasty trial lawyers is PAID PROPAGANDA by the insurance industry.  The real problem is: they are using OUR premiums to undermine OUR rights.  How much of our auto insurance premiums went to paying for those "legislative appreciation receptions" and the "contributions" that are passed on to legislators throughout America?   

And those premium dollars also go to pay for advertisements designed to create disdain amongst the citizenry against plaintiffs and trial lawyers.  In Washington State alone, the insurance industry recently spent over $19 MILLION dollars of premium money collected from its customers to advertise against two pieces of consumer legislation sponsored by the trial lawyers.  Washington is an enlightened State, and so on both occasions, the voters soundly spanked the insurance industry and approved consumer oriented legislation by over 58%.

Back to the so-called “contributions” the insurers make with our premium dollars.  They use our money to undermine consumer rights.  Those bald bribes have bought access to lawmakers in the majority of states, and that fact is reflected in the grossly unfair outright elimination of the collateral source rule in about 20 states.  The collateral source rule is still allowed for auto accident victims in most states, but with certain restrictions.  You can see how the rule is modified here(if your state is not listed, that means your legislators have stood firm with the trial lawyers and FOR citizen rights and against the moneyed interests.  http://www.namic.org/reports/tortReform/CollateralSourceRule.asp

Hence, I would say nothing to the adjuster.  TAKE THE POSITION THAT THE MONEY IS RIGHTFULLY YOURS SINCE YOU PAID FOR THE HEALTH INSURANCE.  Even if the collateral source rule is not applicable in your state, the insurance company will let you know.  BUT MAKE THEM CITE A STATUTE rescinding the common law collateral source rule.

If they insist upon taking the medical bills off of the award you will get, I would argue with them that by the "collateral source rule" in your state they are not allowed to introduce testimony that the bills have been paid, and hence they have to pay you.  Let THEM produce the authority to the contrary since the collateral source rule is the norm in most states(at least until our President and other pawns of the insurance industry prevail with so-called "tort reform").

There is no fraud involved in this inasmuch as you have every right to believe that what you paid for belongs to you and not to the insurance industry.  Stand firm on your rights.

I trust that my efforts here have been of benefit to you, and hence I respectfully request that you find the FEEDBACK FORUM on this website and leave some feedback for me.

Best Wishes, Dr. Settlement, J.D.(Juris Doctor)Http://www.SettlementCentral.Com