Subrogation Law

[Beltran]

I got into a accident back in 10/2001(NY State).  I got a settlement of $100,000 from the other insurance company in 2004 and my lawyer paid almost $14,000 to my insurance company.

Two years later I still don't understand why this was done.  I went had the surgeries not them.  I suffered not them, I have a partial disability and I lost my job not them.  What part of law tells that I have to give them proceeds of my settlement when I had $50,000 mandorty PIP, $100, APIP and $25,000 OBEL?

Why did I pay for $100,000 of APIP if it wasn't available to me when needed.

Also I just found out that at the time of my settlement my bills were at $70,000 for PIP because they didn't use any for the OBEL which should have covered loss of wages(2) and physical therapy(3) combined under(4).  This would have given me under $50,000 used in PIP and I would have used all $25,000 in OBEL.

I also just found out they had never sent me a letter to choose what coverages I wanted my OBEL to go to.

Why did I have to pay this when I had so much coverage?

[Matunaagd]

Hi,

Thank you for the opportunity to answer your question.  The no-fault insurance company is not entitled to be reimbursed for any amounts paid for medical treatment which total less than $50,000.  If you obtain reimbursement from a third party, they are entitled to be reimbursed for the amount that they pay in excess of $50,000.  If you did not have a lawsuit or was unable to recover money, then your insurance company would not be entitled to reimbursement of moneys paid in excess of $50,000.

No-fault insurance is primary and major medical insurance is secondary which means that in a car accident, major medical health insurance will only be required to pay after a bill has been denied by the no-fault insurance company.

If your no-fault insurance company had denied you further coverage after sending you to be examined by their doctor, your major medical health insurance would have paid for your medical bills and would not be entitled to be reimbursed.

You could try to send your medical bills to your major medical insurance company, if you have one, but your coverage may require that you have had a referral first.

The additional PIP was available to you and apparently $20,000 of that coverage was paid.  It appears that your attorney settled the $20,000 additional PIP reimbursement claim for $14,000.

To answer your question as to what part of the law allows reimbursement, you may be able to find that in the New York State Insurance Law.  You should be able to find that at http://public.leginfo.state.ny.us/menugetf.cgi?COMMONQUERY=LAWS  I just looked there and it says that the page cannot be displayed, however, you can also look at http://caselaw.lp.findlaw.com/nycodes/  

I would look first at section 5102 of the Insurance Law, which you can find at http://caselaw.lp.findlaw.com/nycodes/c52/a34.html

As far as your not receiving a letter allowing you to choose your coverage, it is likely that you did have this form among many other papers.  Unfortunately, there are several choices you can make, none of which are readily apparent among all the fine print.  For instance, in New York State you now must elect coverage allowing you to sue your spouse for negligence, assuming that you are married and injured in a car accident due to the fault of your spouse.  

Even more importantly, most insurance agents will sell increased liability limits such as $100,000/$300,000 but never advise you to purchase inexpensive matching underinsured/uninsured coverage.  Unless you know what to look for, this is not obvious in the papers.  If you have liability insurance in excess of $25,000, make sure that you have matching underinsured/uninsured coverage. Underinsured/uninsured coverage is probably the most important coverage.

My legal malpractice company and AllExperts.com require that I advise you that the above is not legal advice for you.  It is only my opinion as it would apply to myself if I were in this position.  For legal advice, you should formally contact a lawyer.

I hope I have been of some help.  If you have any further questions, feel free to let me know.  I would like to thank you for requesting my advice and I would appreciate your leaving a comment for me at AllExperts.com.  If you feel my answer was worthwhile, please check the box to nominate me for volunteer of the month.

Thank you very much, good luck and be sure to check out my web site www.HURT911.org which has a lot of useful information for Accident & Injury research.

Philip L. Franckel, Esq.

Former Member Board of Directors,

New York State Trial Lawyers Association

telephone: 516-621-9399

email: [email protected]

website: the CENTER FOR INJURY ASSISTANCE® at www.HURT911.org