Your Health Insurance and Your Injury Claim
If you’re reading this, you’re wondering about whether your health plan has a right to get paid back from your potential injury claim settlement. Perhaps I’ve told you to look into this or maybe you’ve just arrived at this concern on your own. Either way, a phone call needs to be made. But what needs to be asked?
When you call your health plan, tell them you live in North Carolina and were involved in an accident that someone else might be responsible for. The health plan is paying for your treatment, but you want to know whether or not the health plan has what they might call a right of subrogation, or perhaps a right of reimbursement against third party proceeds. Ask them who you would need to talk to to get that question answered.
If you’re lucky, they’ll send you to the right place immediately. Normally someone will take your information and then they’ll have a third party company (often The Rawlings, sometimes Conduent, or perhaps another organization) reach out to you. When they do, you should put them in touch with your attorney, which is hopefully me. If you’re not represented, good freaking luck. Do they have a valid right of reimbursement? How would you know? What does your Summary Plan Description say? Do they file a Form 5500? This stuff is wacky, so you might want some help.
If you’re unlucky, the person with whom you’re speaking won’t have a clue as to how to help. In my experience that just means you call back later and hope to get a different person. Sometimes you can cut to the chase and learn from your Summary Plan Description (SPD) if this is something you even need to be worried about. That’s also where an attorney can probably help you. Those things are written in ancient legaleze.
For more information on this issue, check out this post.
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