Health Insurance and Your Injury Claim: The Good, the Bad, and the Ugly
If I have represented you in an injury claim before, you know what I say: USE YOUR HEALTH INSURANCE! THAT’S WHAT IT’S THERE FOR!
Now that I have that out of the way, let’s talk about a few of the particulars regarding health insurance and your injury claim.
THE GOOD: If you have health insurance, you’re lucky! This is exactly why you have it. Health insurance helps to bear the brunt of your health care costs. In an injury claim, my job is to help reimburse you for the costs of this care. In the North Carolina injury claim context if you don’t have health insurance, you’re responsible for all of your health care costs up front, and that can be quite a burden to bear. So if you have it, use it! Of course, there are exceptions to every rule, and we can talk more in detail about those exceptions (when you might not want to use your health insurance) if I represent you.
THE BAD: There are two bad things about health insurance and your injury claim that immediately spring to mind. First, thanks to our insurance-friendly republican legislature (those culture warrior geniuses who brought us HB 2, the most financially disastrous legislation for NC businesses ever passed), the at-fault party in your claim gets a credit for the discounts that your health insurance has negotiated with your provider. Sucks, but there it is. Second, there are SOME health insurance plans (ERISA plans, Medicare, Medicaid, NC State Employee Health Plan, for example) that have a right to get paid back from your settlement the amount that they paid for your care. If you have one of these plans or a plan with a similar right (most NC plans disallow this, but there are exceptions) then that serves to substantially reduce your recovery. It’s not the end of the world, and if you didn’t have the coverage your costs would likely be higher AND they’d just go to the provider anyway. But still, this can be a drag.
THE UGLY: The worst is when you have a Cost Plus plan. I won’t bore you with what that means, but the short version of the ugliness is these plans come from a statute that is worded somewhat vaguely (thanks again, legislator ding dongs) and as a result the plan administrators claim that they, too, enjoy the right of subrogation/reimbursement that ERISA, etc. plans claim. This is not what the statute says, but it’s what they think it might be interpreted to say. This is, to say the least, a wishful stretch on the part of these plans. So if you have one of these, you may likely end up in a fight about what, if anything, they have a right to get back. So far, I haven’t seen any mandatory case law on this issue that serves to settle the statutory interpretation, but it will come one day, and this may not be so ugly anymore. Or it might get uglier.
Of course, always look to your attorney for legal advice specific to your claim, and don’t do stuff just because I wrote it down in my blog. This piece is just for general information and is not legal advice specific to your claim. Call me and hire me for that!
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