There are some health insurance companies may want you to reimburse them for any medical expenses paid on your behalf for your injury. Most health insurance companies have a clause about “rights of subrogation.” This is a term that means a health insurance company can get payment for the services provided if you get a settlement or court award for a personal injury lawsuit. The “right to subrogation” also means that a health insurance company can start a lawsuit in your name to collect for the medical expenses paid on your behalf.

New York however, limits which companies qualify for reimbursement. New York also gives the opportunity to lower the reimbursement amount on certain situations. In many instances, New York prohibits insurance companies from reimbursement actions unless the settlement or court award specifically states that covered medical expense are included and should be paid out. For example: if in a car accident you sue for pain and suffering and not medical expenses, then a health insurer would not be entitled to receive a reimbursement.

Furthermore, under New York’s General Obligation Law there are specific regulations that must be reached. If any one or both of these requirements are not met, then the health insurance company cannot collect a reimbursement. (There are different laws if you are insured by Medicare or Medicaid.)

Health insurance companies that want reimbursement for medical expenses related to a personal injury settlement or court award should be verified. There is not an automatic reimbursement. The health plan and documents are where it is stated if the health insurance company is entitled to a reimbursement. The plan must state that:

• It is self-funded (an employer pays out of its own funds) and qualified for ERISA
• It is entitled to a reimbursement when there is a settlement or court award
• It intends to pursue reimbursement
• Form 500 filed with the IRS to prove that it is self-funded

Note: if a plan does support a reimbursement, it can only receive reimbursements for the personal injuries related to the specific case.

For example: If in a car accident and you suffer from a back injuries and are also seeing an allergist, the health insurance company could not request reimbursement for the allergy expenses. However, even where the health insurance reimbursement claims have been verified, there may be ways to reduce the amount.

Barton Slavin

With over thirty three (33) years as a practicing attorney Barton L. Slavin, Esq. leads a staff and network of experienced attorneys that meets both corporate and personal legal needs.

Contact Barton Slavin, Esq. of Slavin & Slavin, Esqs. at (212) 233 -1010 or send an email to barton@nycattorneys.com. Consultations are free.

We work hard to make sure that all of your concerns are properly addressed and that your matter is resolved in a timely manner. Slavin & Slavin Attorneys at Law

What makes Barton L. Slavin different from other attorneys is that he has an in-depth knowledge of the medicine and an understanding of effective communication methods to present a case to the jury in the Courtroom or the Mediator in a settlement meeting.

Your case will be prepared with the guidance and advice of Hon. Joseph Slavin, who as a Trial Judge for 20 years presided over approximately 1,000 Jury Trials (Medical Malpractice, Tort, Felony Criminal Cases including Homicide and Drug Cases).

Barton L. Slavin received an AV Rating of Very High / Pre-eminent Martindale Hubbell Lawyer Rating. This is the highest ranking, which signifies that the lawyer has reached the heights of professional excellence.