If I win my North Carolina auto accident injury lawsuit, do I have to repay my health insurance company?

Maybe. It depends on your health insurance policy.

If you are covered by medical insurance, your insurer may have paid for a portion of your care after your traffic accident in North Carolina. You, too, would have been held responsible for paying any deductible and co-payment amounts specified in your policy.

If you later get a settlement or jury award from your lawsuit against the person liable for your accident, your insurance company may ask for the money it paid for your treatment to be returned. Your insurer’s reasoning is that, as long as someone else is legally responsible for paying your medical bills, they should not be forced to do so.

There may be a specific provision in your health insurance policy that gives the insurer the right to recoup the money it spent on your behalf if your injuries are due to someone else’s fault. Even if your policy does not specifically grant the insurance company this right, insurers may rely on a common-law principle, called the right of subrogation, to make a claim on some of your settlement money.

How this works out in practice depends on whether you have won your case against the driver who injured you:

  • If your case is still in progress, your health insurance company may join you as a plaintiff against the person who caused the accident. The insurance company would only be able to seek damages up to the amount of money they spent on giving you health care benefits.
  • If you have won your case or settled the claim against the person responsible, your health insurance company could end up suing you to recover the benefits it gave you. In many cases, the insurer will begin by politely asking for the money—using what’s called a demand letter—addressed to you and your North Carolina traffic injury attorney. Only if you refuse to pay will a lawsuit be filed against you.

 

What to do in a North Carolina health insurance subrogation case

Ultimately, you will probably end up repaying your insurance company. The services of an experienced Wilmington personal injury law firm can be helpful here: your attorney can negotiate with the insurer to make sure you remain compensated fairly for your deductible, co payment, and out-of-pocket health care expenses. In some cases, insurance companies cannot claim the right of subrogation, and your lawyer should be able to advise you when you need not pay.

Even if you are compelled to reimburse your health insurer, that only means you will not be “double-dipping” compensation for medical bills. And the insurance company cannot touch any settlement you get for pain and suffering, lost work income, disability, disfigurement, property losses, and occupational and rehabilitative therapy.

The skilled traffic accident lawyers at Speaks Law Firm in Wilmington are ready to answer any of your questions about your potential lawsuit. Call them today at 910-341-7570 or toll-free at 877-593-4233 to schedule a free evaluation of your legal case. Just for calling, they would like to send you a FREE copy of The North Carolina Auto Injury Book by R. Clarke Speaks.