Think you might have an ERISA plan?
Health insurance is supposed to be there to cover you when you need it. And, for the most part, it kind of is. But should they have the right to get paid back from your injury claim proceeds? According to some plans, they should.
North Carolina generally doesn’t allow this right of reimbursement to third party claims on the part of health plans. Sometimes this is referred to as “subrogation” but that may not be precisely the right word depending on plan language. As you can imagine, there are exceptions to every rule. One of those exceptions is if you have an employer-sponsored ERISA health plan. Those plans are set up under a Federal law that supersedes State law and allows health plans to get back what they paid out when/if an insured gets paid from a “third party” (like in an auto accident) for the incurred medical expenses.
We can talk about why these plans were designed with this right, but that’s for another post. For now, the issue is whether or not YOU have one of those plans and if you do, are we going to have to pay them back from your settlement.
IF your plan has this right you don’t want to ignore this potential right because they can take away benefits and/or might pursue you in court for the payback, so don’t play around. As such, we need to do some digging.
So what should you do now?
Call your health plan with your insurance card in hand and ask them if your particular plan has a “right of reimbursement for third party claims” or “subrogation in third party claims.” If they claim to have such a right, have them get you to the right people to set that claim up and give that information to your attorney. That should get us to the right folks so we can then discuss with them the source of their perceived right and the amount of payment, if any, to which they may be entitled.
This stuff can get complicated and it’s important to make sure you’re on the right track. Talk to someone who knows what’s up. Talk to me. 919-929-2992.
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