When your health insurance covers necessary medical care resulting from a personal injury and you receive a settlement, health insurance liens are attached to the settlement funds. Allowing the wounded plaintiff's health insurance to cover the cost of their accident-related care is nearly always preferable. Discover the benefits of allowing your health insurance to pay for your auto accident.
The majority of health insurance plans contain wording that gives the policyholder the right to file a health insurance lien. Should your health insurance policy contain lien language, you would have consented to payment at the time of policy signing. The majority of people are ignorant of the policy language's legal implications.
It is only after an injury that they learn about the health insurance lien. There are several things you should be aware of in the event that you have to deal with a health insurance lien.
Which laws apply to your insurance lien?
Finding out which law is applicable is the first step. The terms of health insurance policies produced in Florida are regulated by Florida Statutes.
The six things you should know when you find yourself injured because of the negligence of others, and end up with a health insurance lien:
1. Read Your Health Insurance Policy to Determine If There Is a Health Insurance Lien
First of all, a health insurance coverage is a legal agreement. It is not safe to presume that your health insurance provider has a lien because contracts are based on the terms of the agreement. Insurance companies have asserted that they have a lien on health insurance even in cases where the policy did not grant such a right.
To make sure the policy permits a health insurance lien, read your policy or provide it to your lawyer. The exact health insurance lien that your health insurance has on settlement money will be specified in the policy language, if any. Remember that certain insurance do not apply to uninsured or underinsured motorist settlements; they only cover third-party settlements.
2. Your Health Insurance Company May Only Recover Payments for Medical Care Related to Your Claim
Remember, your health insurance company only has a lien for payments pertaining to your injury. They have a right of recovery for the payment of medical care. Verify with your lawyer that the lien is exclusively applied to the expenses associated with your injury claim.
Requesting an itemized lien from the insurance provider, which outlines all of the payments they are attempting to recover, is the first step in verifying this. Any payment indicated that has nothing to do with your claim should be reported right away to the insurance carrier by your attorney.
3. Health Insurance Companies Must Take into Account Attorneys' Fees and Costs When Determining Health Insurance Liens
The majority of personal injury lawyers take cases on a contingent fee basis. This implies that they will only get paid if their client receives a financial settlement. The attorneys' fee in these situations is based on the client's recovery as a percentage. The client is also responsible for paying back the attorney's out-of-pocket expenses from the case.
According to Florida Statute 768.76(4), a lienholder's entitlement to reimbursement is only applicable to the real amount of collateral sources that they are able to get from a tortfeasor, less their pro rata part of the expenditures and legal fees they have to pay to do so.
4. Liability and the Amount of Insurance Coverage Matter in Health Insurance Liens
Fourth, a jury must determine each party's percentage of fault in cases where multiple parties are involved in the accident. We refer to this as comparative neglect. In some situations, the insured party may be found partially at fault and have their damages lowered. In these cases, the health insurance provider ought to lower its lien to reflect the fact that the injured person is not getting paid in full. That is to say, if the other party is given a 50% blame assignment, the lienholder cannot get more than 50% of their lien.
Health insurance companies must also assess what the overall value of the claim would have been had there been a full recovery and modify their collection efforts accordingly when a recovery is restricted by the quantity of insurance available.
Statute 768.76(5) in Florida mandates that the court take into account any factors that may offset the amount of judgment or settlement for the claimant's comparative negligence, limitations on the amount of liability insurance coverage available to the tortfeasor, or other mitigating factors that the court deems appropriate and equitable in the given circumstances.
5. The Lien Cannot Increase After the Date of Settlement or Judgment
The provider is expressly prohibited from asserting a right of subrogation or reimbursement for payments made to collateral sources after the date of waiver, settlement, or judgment by Florida Statute 768.76(8).
6. The Health Insurance Carrier Must Reply Within 30 Days to a Registered Mail Notification of Claimant's Intent to Claim Damages or the Lien Is Waived
The process set forth by Florida Statute 768.76 is very specific so rather than summarize it the relevant portions are below.
"(6) A claimant shall send the provider of any collateral sources, by certified or registered mail, notification of claimant's intent to claim damages from the tortfeasor. If the claimant has filed suit against the tortfeasor at the time such notice is sent, a copy of the complaint against the tortfeasor should be sent along with such notice. Such notice must include a statement that the provider of collateral sources will waive any right to subrogation or reimbursement unless it provides the claimant or claimant's attorney a statement asserting payment of benefits and right of subrogation or reimbursement within 30 days following receipt of the claimant's notification to the collateral sources provider."
"(7) Within 30 days after receipt of the claimant's notification of intent to claim damages from the tortfeasor, the provider of collateral sources must provide the claimant or claimant's attorney a statement asserting its payment of collateral sources benefits and right of subrogation or reimbursement. Failure of the provider of collateral sources to provide such statement to the claimant or claimant's attorney within the 30-day period shall result in waiver of any claim to subrogation or reimbursement by the provider with respect to any such collateral sources. No right of subrogation or reimbursement shall exist for a provider of collateral sources that has waived its right of subrogation or reimbursement pursuant to this subsection."
It might be difficult to resolve health insurance liens. Every case is unique, and the parties frequently cannot agree on which law should be used. Sometimes, health insurance firms argue that federal law or even the laws of another state regulate their policies. Pay no more than what is necessary in accordance with your policy or the applicable laws.