One of the biggest issues in every case it’s going to be the payment of medical expenses. It’s an area that’s of a Normas concern to just about everybody. What I encourage all of my clients to do is to make sure that their medical expenses get paid either through health insurance or some other form of insurance rather than being paid through the settlement proceeds. Letting Your medical expenses get paid I health insurance or some other source.... It’s not their fault that you got hurt in an accident either and they will have a right to get reimbursed money out of the settlement proceeds. It becomes the perfect way to put the responsibility of getting those medical expenses back on the purses his accident who’s fault it was.
The most common example of paying someone medical expenses out of your proceeds would be with your health insurance. Your health insurance policy will have a clause in the policy which is called the subrogation clause. This clause says that if you collect money as a result of settlement from some other person you have an obligation to reimburse us out of the settlement proceeds. That’s the most common example. Another place it just see that is in automobile insurance policy if you use your medical payments coverage as a way to get your medical expenses paid there will be a similar kind of clause in your automobile insurance policy. The last place where you may have the responsibility to pay someone for medical expenses out of your settlement is through Worker’s Comp. This is a broader obligation we are just paying back your medical expenses you also have an obligation to pay back all the medical benefits that you got through Worker’s Comp. which would include disability benefits, your medical expenses, and any type of settlements what you got a connection with the workers comp case.
If you’re on a government related programs like Medicare you also have a legal requirement to reimburse the government program out of the settlement proceeds. One thing that’s becoming incredibly sensitive issue in my field is the way that the Medicare statute is written is that if Medicare is in properly reimbursed, it gives the government the ability to recover that money not just the purse from the person who got the settlement money, but all the insurance companies involved, the lawyers involved, the defendant involved, and everybody else.
The basis for reimbursement Is determined by what was actually paid out or accident related care. So for example if you broke your leg in an accident and we’re also on medication for her heart condition. The only thing that would be part of the reimbursement would be care that was related to your broken leg, you wouldn’t have to reimburse the government or Blue Cross Blue Shield for the cost of your cholesterol medication. The good news is that whether it’s Medicare or Blue Cross Blue Shield or whoever else, pay far less for your medical care then was actually built by the hospital. If you go to an emergency room for what might be a simple rear end accident with very few injuries, You might be billed $5000 but the pair will pay $2000 or less. So the basis of your reimbursement will actually be the $2000 that was paid out not the gross amount amount that was actually billed. What you would reimburse the government or Blue Cross Blue Shield or whoever it is for would not be the full $2000 or whatever it is but Alesso figure which accounts for the cost of your recovery. They have to account for costs and attorneys fees and so forth so the net reimbursement to the government is usually about 60% to 65% of what they actually paid out. The good news at all this is that what has to be reimbursed when all is said and done is far less than the gross amount billed.
People typically make mistakes at two points with regard to the reimbursement obligation. The first of these is that people are really aware and conscious of it and don’t fully taken into account When negotiating things with the insurance company. If it’s not specifically accounted for in terms of your negotiation with the insurance company, what they’ll do is issue you a check with toupees on it. The check will come payable to you and to Blue Cross Blue Shield for example. If you were to get that check deposited, you’re going to have to work things out with blue clock cross Blue Shield or whoever the other payee is on the check. That’s one place where people tend to make mistakes. The other is when people are actually aware of what their reimbursement Obligation is they know there’s some amount that needs to be paid out. They sometimes end up paying out money for things they really shouldn’t be paying back is part of the Reimbursement obligation.
Barry Doyle Personal Injury Attorney [email protected] 312-766-4875 www.fightingforwhatsright.com
