Is it true that you have to pay back your health insurance after being injured in a car accident?

Posted By Matthew Clawson || 23-Jun-2014

The short answer: "Yes." Amounts paid by your health insurance for treatment for your injuries from a car accident must be paid back to your health insurance company from any settlement that you may obtain from the striking driver's insurance. Now here's why—and how having a personal injury lawyer can often decrease the amount you have to pay back.

Whether you have health insurance through your employer, or you bought it yourself through the new Colorado health insurance exchange, or you have a Medicare Advantage plan, your health insurance is really a contract between you and your health insurance company. All health insurance contracts contain language that says that, if your health insurer pays for your accident treatment, you promise to pay back your health insurance from any money you obtain from the negligent driver (or his insurance company). The thought is, had the other driver not been negligent to cause your injury, your health insurer would not have to cough up the money to pay for your injury medical care—so the striking driver should be the one to pay for your medical care, including paying back your health insurance who paid for your medical care. Recovering the expenses of the accident medical care from the negligent driver helps keeps health insurance premiums lower (they say).

If your medical expenses are paid for by a government program, such as original Medicare or Medicaid, federal and state law requires you to pay these government programs back for injury-related medical care. Failure to reimburse government programs can threaten the continuation of your benefits or cause substantial fines to be assessed against you. You don't want to fool around with demands for repayment from Medicare or Medicaid when you have been injured in a car accident!

How can a personal injury attorney help with all this? First, and foremost, when you work with a personal injury attorney, you will maintain your medical privacy, and you will not have to let the striking driver's insurance company have unlimited access to your medical history and medical treatment. This gives lots of claimants peace of mind, because who wants all their medical information to be an open book for an auto insurance company?

Additionally, when you work with an experienced Colorado Springs personal injury attorney, he or she will:

  • obtain your medical records and bills to closely examine what treatment was actually needed because of the car accident
  • determine whether medical providers were overpaid by health insurance or Medicare/Medicaid
  • establish a working relationship with the agent for the health insurer (or Medicare/Medicaid) who has the job of recovering medical expenses from your personal injury settlement
  • determine whether the health insurance company (or Medicare/Medicaid) is seeking to be reimbursed for medical bills that did not relate to the car accident
  • frame the evaluation of your case for settlement to reflect what you have to pay back so your settlement is maximized for your situation
  • negotiate with the reimbursement agent to reduce the reimbursement amount as much as possible, considering both your particular health insurance plan and the limited monetary recovery available from the striking driver's insurance
  • knowing and following the law of Medicare/Medicaid to address the repayment requirements and the government forms that have to be filed to be in compliance with these government agencies

An experienced Colorado Springs personal injury lawyer can save you lots of stress in managing the thickets of health insurance payments and forms, which can certainly help you recover more quickly from your injuries.

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