Health Insurance, Auto Insurance, & Subrogation in Ohio
Many clients are not aware that their health insurance and automobile insurance companies have a right to recoup any medical bills that they pay relating to a personal injury claim, despite the fact that clients have paid their premiums to have such coverage. The right of insurance companies to recoup these medical bills is called a subrogation claim.
These subrogation claims are extremely unfair to policyholders. In a perfect world, insurance companies would not have any right to recoup medical bills just because an automobile accident or motorcycle accident occurred (that they did not cause, by the way). Unfortunately, under Ohio law, health insurance and automobile insurance companies have the right to make this claim.
In this article, we’ll discuss subrogation in more detail and explain your rights.
No one expects to get injured in an automobile, truck, motorcycle, or bicycle accident. Sadly, such accidents are all too common in Ohio and are often caused by other negligent drivers. When such incidents occur, the help of an Ohio attorney can help you reach a just settlement with the other party. If you receive a settlement, this is where subrogation can become an issue.
Remember, in the state of Ohio, health insurance and automobile insurance companies have to be paid back for medical bills when a settlement has been obtained.
With the upsurge of these subrogation claims by health insurance and automobile insurance carriers, it is becoming extremely important to successfully communicate with carriers and aggressively negotiate these claims in a way that best represents your interests.
Whenever you have a subrogation claim, you first need to identify the subrogated interest you are dealing with. It can be either:
(1) health insurance (determine if ERISA or not);
(2) a medical payment provision from an auto policy;
(3) Medicare – 42 U.S.C. 1395 Y(B)(2)(b)iii;
(4) Medicaid – O.R.C. 5101.57 – 5101.59; or
(5) Workers’ Compensation (BWC and self-insured) – O.R.C. 4123.93.
There is no place where the proper handling of subrogation is more important than in an automobile accident case. Insurance companies are paying less on these auto cases and the risk of non-recovery or unsatisfactory recovery is growing.
We also recommend that you send a request, via certified mail, for copies of your plan documents to verify that a right of subrogation exists and if the subrogation language is contractual.
Furthermore, engaging an attorney who can help you make these arguments could help you reduce subrogation-related issues.
Dealing with a Subrogation Claim?
If you live in the state of Ohio and need assistance dealing with a subrogation claim, our team at The Law Office of Tom Somos, LLC is here to assist you. Contact us to schedule a free consultation.