As any qualified personal injury lawyer will tell you, one of the elements of damages and recovery in a personal injury case is past and future medical bills. In other words, in addition to other elements of damages you may have suffered, you are entitled to recover any past or future medical bills caused by your injury. However, if some or all of those medical costs were paid by a health insurer or government benefit plan, those costs must normally be reimbursed from your recovery in settlement or trial. Your attorney needs to be familiar with this complex area of the law.
If either your own health insurer, or the health insurer of your employer’s health plan, paid any of your accident-related medical bills, it may seek reimbursement out of your personal injury recovery. Sometimes the health insurer even hires lawyers to pursue injured accident victims for this recovery if they fail to pay it. This area of the law, known as “reimbursement” or “subrogation,” is quite complicated.
Sometimes, health insurance subrogation is governed by a federal law called ERISA (The Employee Retirement Income Security Act of 1974). Under other circumstances, state law governs the subrogation. The healthcare insurer’s right of reimbursement or subrogation can be different from case to case depending upon which law applies, as well as the wording of the health insurance policy itself. Your attorney must understand the implications of both ERISA and Louisiana subrogation law on your case to properly represent you and avoid unpleasant surprises when your case is concluded.
If your bills were paid by Medicaid, Medicare or the United States Government (including military care), your attorney will need to understand the different special laws and procedures under each to determine and negotiate what is owed in reimbursement or subrogation.
If you are not insured by a health care insurer or government program, and you have unpaid medical bills from a hospital or other health care provider, they are normally entitled to be reimbursed out of your recovery as well. The right of reimbursement will be different for different types of health care providers. The rules that apply to the recovery by ordinary private hospitals or health care providers, for instance, are different from those that apply to state hospitals. Still different rules apply to the recovery by health plans covering federal employees and military personnel.
Your personal injury attorney must be familiar with all the rules governing the rights of reimbursement or subrogation applicable to your particular case.
Following graduation from Loyola Law School in New Orleans in 1990, Price McNamara served as a Federal Judicial Law Clerk to the Honorable John M Shaw, Chief Judge, United States District Court Western District of Louisiana.
Mr. McNamara founded the Law Offices of J. Price McNamara, and began putting his past experience to work for the injured and disabled clients he now represents against the insurance companies in personal injury and long term disability and other insurance disputes in both federal and state courts