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Health Insurance Subrogation in California Personal Injury Lawsuits

Health insurance liens can be complicated and confusing, which underscores the importance of retaining an experienced attorney to navigate the complex landscape of personal injury lawsuits in California. This article aims to provide a general understanding of health insurance liens, particularly as they relate to personal injury claims in California.

Health insurance subrogation refers to the right of health insurance carriers to seek reimbursement for accident-related health insurance benefits paid on the claimant's behalf. This concept exists to prevent "double dipping," where an injured party receives compensation for their medical expenses from both their health insurance provider and the party responsible for their injuries.

In California, private health insurance subrogation rights are based on the contractual agreement between the insured and the insurer. In contrast, the subrogation rights of government-funded healthcare programs, such as Medicare and Medi-Cal, are governed by statutes.

Statutes that govern Medicare and Medi-Cal reimbursement leave less room for flexibility when it comes to negotiation and impose harsh penalties on claimants who fail to satisfy their subrogation liens. For example, under the Medicare Secondary Payer Act (42 U.S.C. §1395y), Medicare has a right to reimbursement for any payments made related to a personal injury claim. Failure to satisfy Medicare's lien can result in penalties, including double damages and interest.

Fortunately, health insurance subrogation liens can often be negotiated to something less than the full amount by an experienced attorney. Some of the arguments that can be asserted to achieve reductions in the lien amount include:

  1. The "Made Whole Rule": This rule states that the insured must be "made whole" or fully compensated for their injuries before the insurer can recover any subrogation interest. If the insured's recovery from the at-fault party does not fully compensate them for their injuries, an attorney may argue that the insurer should not be entitled to reimbursement.

  2. Unrelated Charges: An attorney may argue that certain medical expenses are unrelated to the accident and should not be subject to the lien. This could include expenses for pre-existing conditions or unrelated treatments.

  3. Causation Issues: If the injury was partially pre-existing or there are other factors contributing to the injury, an attorney may argue that the lien should be reduced based on the proportion of the injury attributable to the accident.

It is essential to have an experienced personal injury attorney by your side when dealing with health insurance liens in California. They can help you navigate the complexities of the process, negotiate lien reductions, and ensure that you receive the compensation you deserve.

If you or a loved one has been injured in an auto accident, contact Phillips & Associates for a free consultation today. You will immediately be put in touch with John Phillips or Patrick DiFilippo, who can help determine whether you have a case and advise you on the best course of action moving forward.


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