Many of our personal injury clients find something surprising happening in the middle of their case that they didn’t expect: a request from their health insurance company to be reimbursed for your injuries. This process of reimbursement is called subrogation, and it’s a complex circumstance that can muddy a case that’s already causing enough confusion and hardship for you as it is.

Q: What is subrogation?

A: Subrogation is an insurance term for a process whereby the insurance company seeks reimbursement for the coverage they paid for medical expenses from the at-fault party who actually caused the injuries. It primarily occurs after the expenses of a claim have already been covered, but the insurance company wants to be reimbursed for the money they spent on covering their insured’s injuries when those injuries weren’t actually caused by their insured customer.

Q: Why does subrogation exist? 

A: Insurance plans are designed to cover injuries caused to you, regardless of fault. For instance, if you were to accidentally injure yourself, like falling out of a tree, your insurance company would cover those self-inflicted injuries. However, in scenarios such as a car accident where another driver is responsible for causing the injuries, your insurance company will step in to cover your claim. Yet, they will actively pursue reimbursement from the at-fault driver because that individual is the one directly responsible for the injuries you sustained.

Q: What are examples of subrogation claims?  

A: Subrogation commonly arises in cases of property damage, personal injury, or other covered losses. For instance, if you sustain injuries in a car accident caused by another driver, your health insurance company may cover your medical expenses. Subsequently, the insurance company might initiate the subrogation process to seek reimbursement from the at-fault driver’s insurance for the medical costs it paid on your behalf. 

Q: Is subrogation legal?

A: The applicability of subrogation can vary based on the state in which you reside or where the injury occurred. For instance, in Missouri, there are specific regulations prohibiting automobile companies from subrogating against health insurance providers and vice versa. Notably, only self-funded health benefit plans, which are plans not provided by an employer, are permitted to engage in subrogation in Missouri. It’s crucial to thoroughly review your state’s laws to gain a better understanding of how subrogation might unfold in your particular case.

Q: Can subrogation be waived?

A: In certain instances, insurance policies may contain clauses that either limit or waive subrogation rights, contingent upon the specific terms of the policy and the prevailing laws within the jurisdiction. The ease of navigating these matters often hinges on the nature of your medical insurance plan. If you are covered by a private insurance provider, our team may find it more feasible to negotiate adjustments or explore alternative arrangements pertaining to subrogation. However, complexities arise when dealing with medical insurance plans provided by employers due to distinct regulations. Governed by the Employment Retirement Income Security Act (ERISA), this law outlines the minimum standards that employers must adhere to for insurance coverage, concurrently safeguarding employers. Notably, ERISA grants the insurance company associated with your employer the right to pursue subrogation, frequently allowing them to claim the entire amount initially covered. Navigating these intricacies requires a comprehensive understanding of both insurance policy specifics and the legal landscape, and our team is adept at managing such complexities to ensure optimal outcomes for our clients.

Q: How long does subrogation take?

A: Much like the process of a personal injury case or trial, reaching the end result of subrogation can take weeks, months, and sometimes years. It all depends on the circumstances of the accident, the state where it occurred, and the complexity of the claim. Subrogation can sometimes happen in tandem with the case as it unfolds, or its processes may not be enacted until after the case is fully settled, which means it could be delayed by quite some time.

Q: Do I need to do anything regarding subrogation?

A: If you’re working with a personal injury attorney on your accident case, you generally shouldn’t have to do anything additional to make sure that the terms of your subrogation are appropriately discussed, negotiated, and met. Your attorney will reach out to and communicate with the insurance company on your behalf to provide the information they need, and most often, the goal is to pay any owed subrogation out of your case’s settlement earnings rather than out of your pocket.

Understanding subrogation is crucial for navigating insurance claims effectively. If you have questions about how subrogation may impact your coverage or want to explore your rights and options, consult with our experienced team at Finney Injury Law. Knowledge is power when it comes to insurance matters – reach out today for personalized guidance tailored to your situation, 314-293-4222.