Health Insurance Payments and Personal Injury Cases


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Health Insurance Payments and Personal Injury Cases

by | Nov 14, 2022 | Firm News

If you’ve been injured in an auto accident, a “slip and fall” incident or in any other types of personal injury accident, you likely received medical treatment for your injuries.

Whether you sustained minor injuries or severe life-threatening injuries, the costs for medical treatment can add up. An estimated 41% of adults in America have accrued medical debt.[1]

Not only are hospital bills astronomically high, but often times you will receive multiple bills for one hospital visit. For example, if you visit the emergency room at a hospital, you will likely receive separate bills for the hospital itself, a bill for the emergency room physician, bills for any radiology images taken and bills for any lab tests performed.

Often times, if you have your own health insurance, your health insurance company may pay for a portion of these medical bills even if you were involved in an accident as a result of someone else’s negligence.

If these medical bills were accrued as a result of someone else’s negligence, you may be contractually required to reimburse your health insurance company at the conclusion of your personal injury case or claim.[2] Your health insurance company’s right to reimbursement is also known as subrogation.

The following is a basic example and overview of how health insurance subrogation may work in the personal injury context:

  1. You are involved in an auto accident and the accident is not your fault. You sustained multiple injuries in the accident and received medical treatment with several providers.
  2. Your total medical bills add up to $100,000.
  3. Your health insurance pays for a portion of your medical bills. Let’s hypothetically assume they pay $40,000 out of the entire $100,000.
  4. You hire Shifrin Law Group to represent your interest in a personal injury claim or lawsuit.
  5. Shifrin Law Group secures settlement or a judgement on your behalf.
  6. Upon the conclusion of your case, Shifrin Law Group will reach out to your health insurance company and request a list of all the medical bills that they paid after the auto accident.
  7. Your health insurance tells us they paid $40,000 and are requesting reimbursement for what they paid.
  8. We attempt to negotiate with your health insurance and attempt to reduce the amount your health insurance is requesting, giving you as much money in your pocket as possible.

The experienced team at Shifrin Law Group is well-versed in negotiating with health insurance companies. Our goal is to make sure you receive fair compensation for your injuries. If you were injured by someone else’s negligence, contact Shifrin Law Group today.


[2] If your health insurance plan is governed by ERISA, the right to reimbursement is governed by special and more restrictive rules.