ERISA Health Plans and Your Injury Claim

NC is an anti-subrogation state, meaning that your health plan CANNOT come back to you after you settle a personal injury claim and ask for repayment of the medical expenses they covered.

However, there are exceptions to every rule. There is a Federal statute referred to as ERISA, and larger employers can set up health plans under this law, which trumps our state law. These ERISA plans are often self-funded and have a right of reimbursement, which means they CAN come back to you after you settle a personal injury claim and ask for repayment of the medical expenses they covered.

Why? Well, other than “that’s the law,” the best answer is that these self-funded plans aren’t insurance; they are a pool of money to which these many, many employees contribute and from which benefits are paid. So instead of it being insurance company money (who cares?!) it’s people’s money (we should all care!), and if there’s a way to get it paid back, that sort of makes sense.

Whether it makes sense or not is somewhat irrelevant in that it will undoubtedly affect your take-home amount from your personal injury claim. Not the end of the world, but it’s important that we know what we’re working with if you have one of these plans. If you don’t satisfy their claim, they can take away your coverage and leave you owing money. No good.

This is all the more reason to have a qualified, experienced personal injury attorney to help you investigate and ask the right questions so that you don’t end up any worse after your injury claim. Call me at 919-929-2992.