What is Subrogation?

Subrogation significantly impacts automobile, trucking collision, and slip and fall cases in Ohio. This article explains what subrogation is and how it impacts your personal injury case.

What is Subrogation?

Subrogation is the right of a health insurance and/or auto insurance company to recoup all of the money it paid for your medical bills as a result of your accident. Even though you pay premiums to have health insurance and auto insurance coverage to pay for all of your medical bills, care, and treatment relating to your accident, your health insurance and auto insurance company have this special right to collect from you all money paid for medical bills at the end of your personal injury case. This claim to recoup all money paid for bills on your behalf is called a subrogation claim. All subrogation claims have to be addressed in every personal injury case, and they significantly impact how much you will recover in your case.

Chain Reaction

Although Ohio law allows you to recover all medical bills and prescription bills as part of your damage claim, when you have to pay back your health insurance and auto insurance company, you are really not fully compensated for all of your medical bills, care, and treatment received. Once you get that money from the negligent driver’s insurance company, you have to turn to your health insurance and auto insurance company and pay them back for all medical bills that they paid on your behalf.

Health vs. Automobile Insurance

There is a difference in the amount of money that you have to pay back a health insurance company as opposed to an automobile insurance company. Under your health insurance policy, your health insurance company will only pay your doctor or medical provider the contractual rate of what your doctor or medical provider accepted. As an example, if you paid $500.00 for an orthopedic consult, your health insurance will not pay your orthopedic the full $500.00. They will only pay him or her the agreed contractual rate which is less than what your orthopedic charged, in some cases $200.00 or $300.00 or less. You would only be responsible to pay your health insurance company back the reduced contractual rate or the $200.00 or $300.00 or less that was paid by your health insurance and accepted by your orthopedic, which he or she accepted as payment in full.

In contrast, when your automobile insurance company pays the same orthopedic doctor pursuant to your medical payments coverage for his or her $500.00 bill as charged, your auto insurance does not have a reduced contractual rate, and the auto insurance company will pay the orthopedic $500.00 in full for the consult as charged. In this example, you would have to pay your auto insurance company $500.00 back to resolve its subrogation claim. As you can see, with extensive treatment, whether your health insurance or auto insurance company pays the bill makes a difference in terms of the amount of money that you would have to pay back to settle the subrogation claim.

There is a benefit when you submit your claims to your health insurance company because you get the benefit of the contractual rate. Be weary of chiropractors and doctors that tell you that they will not bill your health insurance company in an auto accident case. Oftentimes, they are telling you this because they don’t want to accept the lower contractual rate and would prefer billing your auto insurance company so that they can collect their entire bill as charged.

Joining Forces

We always join the health insurance and auto insurance carrier in our lawsuits to protect their subrogation claim so that they are involved in the litigation. When these insurance carriers are involved in litigation, they are usually more willing to negotiate their subrogation claim, and we are often able to secure reductions for our clients.

At the end of your personal injury case, we always negotiate with these carriers. When there are bills that the negligent driver’s insurance company is not willing to pay, we ask the health insurance and auto insurance company to not include these bills. If there are issues regarding liability or there are issues relating to whether all of your injuries are related to your accident, we raise these issues with these carriers so that we can secure a reduction of what you have to pay back. Finally, when there are issues that require us to compromise your personal injury settlement, we negotiate reductions with these carriers arguing that our client was not made whole and did not receive full compensation.

Considering How Subrogation Affects Your Case?

If you are dealing with a subrogation claim, you can reach out to The Law Office of Tom Somos, LLC for an experienced team to stand by your side.

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