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Insider Tips for Texas Personal Injury Subrogation

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Health insurance payback in Texas personal injury

A subrogation claim is made in most Texas personal injury cases.

Handling the subrogation is essential for a personal injury attorney to handle their client’s cases.

The outcome of a subrogation negotiation can make a big difference in what the client receives in their pocket for compensation for the personal injury case.

What is Subrogation for Personal Injury Claims?

Subrogation is when someone who has paid medical bills seeks to pay back those medical bills out of a personal injury settlement. The subrogation interest can arise by contract, by operation of law, or both.

With a car accident claim or an 18-wheeler accident, subrogation could occur by a health insurance company paying medical bills for the personal injury victim and then seeking to be repaid out of the insurance proceeds from the defendant driver.

The vast majority of health insurance companies and other entities who pay medical bills, such as Medicare and Medicaid, have various rights to subrogation or repayment for bills they paid on behalf of the injury victim.

If you have hired a lawyer for a car wreck in Houston, your counsel should handle the subrogation issues for you. If not, here are some things you should be aware of.

What Must Personal Injury Victims Know About Subrogation?

Most personal injury victims don’t care about the gross settlement of their case but care genuinely about the net proceeds after attorney’s fees and expenses. Subrogation claims often are substantial, as the medical bills have been increasing with the rising cost of medical care.

Subrogation means the entity that pays your medical bills after an accident seeks to be repaid if you settle a case involving the cause of the injuries requiring medical care.

If a subrogation claim is made, the claim should be addressed as soon as possible. Negotiation of the subrogation interest can have a very positive effect on the bottom-line proceeds of the personal injury victim.

The injury victim must select an attorney skilled in negotiating subrogation interests when they have had their medical bills paid by a health insurance company or others.

When Health Insurance Pays Your Medical Bills From an Accident?

In Texas, how the subrogation is handled depends on whether the health insurance policy is covered by the Employee Retirement Income Security Act of 1974 also known as ERISA.

Is it an ERISA Policy?

Suppose the policy is self-funded by the employer and not a situation where the employer is simply paying for health insurance. In that case, the policy most likely will be an ERISA policy. Federal law will be applied, which is not favorable to injured people.

Nevertheless, even ERISA policies will work with victims and their attorneys on the subrogation payback with some negotiations.

If you do not have health insurance after being injured in a car accident that was not your fault, you may wonder how you can get medical treatment. Calling a Texas personal injury law firm is a good start.

How Does Texas Subrogation Law Help Personal Injury Claimants?

Surprisingly, Texas has passed a law that helps victims of personal injury when faced with onerous subrogation claims from a non-ERISA health insurance policy.

Now, private health insurance is limited in its subrogation payback to the lesser of:

1. One-half of the gross recovery less attorney’s fees and costs; or

2. The total cost of benefits paid, provided, or assumed by the health insurance company, less attorney’s fees and costs.

The law also limits health insurance subrogation claims against their auto insurance as long as the injured person or their family paid the premiums for the automobile insurance coverage.

*Practice Tip:

If the health insurance company claims ERISA status, obtain the Summary Plan Description.

*Practice Tip: 

Reductions from non-ERISA policies include proportionate costs.

How to Reduce Medicare and Medicaid Liens?

The subrogation procedure can take some time if Medicare or Medicaid is involved in making payments on behalf of the injury victim. Obtaining payouts and negotiating the subrogation claim can be very complicated, particularly with Medicaid.

Reaching out to Medicaid early is always a good approach.

Other subrogation claims could include workers’ compensation if the injury occurred on the job and the employer’s workers’ compensation insurance to pay the medical bills. Still, another party was responsible for causing the accident or injury.

Attaining a positive result for an accident victim often requires negotiation of the subrogation claims of a third party. If you have been injured in an accident and received a letter from your insurance carrier or other entity that paid medical bills on your behalf, consider speaking with a reputable and experienced injury attorney soon as possible before any settlement.

*Practice Tip:

Medicare subrogation includes both PIP and Medical Payments benefits under your policy

*Practice Tip: 

Medicaid can reduce its subrogation claim depending on the injured person’s needs, and they are likely to consider the attorneys’ fees necessary to recover the money.

Workers Compensation

On-the-job injuries frequently are covered by worker’s compensation. When worker’s compensation in Texas pays benefits for medical care or wages, the worker’s compensation carrier will have a claim against any third-party recovery.

In other words, the injured worker covered by Workers’ Compensation will have medical expenses paid and obtain some of their lost wages. The insurance carrier will seek to recover that money if another person or company caused the damages and the injured person collects money from those people.

This includes money recovered from third-party claims.

*Practice Tip:

Worker’s Compensation carriers will consider the need for an attorney to collect the third-party settlement and reduce their subrogation claim for the attorneys who generated the settlement.

Baumgartner Law Firm Fights to Maximize Your Money

Contact us if you want to speak with a car accident attorney in Houston!

At the Baumgartner Law Firm, we are committed to maximizing our client’s monetary recovery in the total settlement amount and the net proceeds to the client.

Call our skilled personal injury lawyers in Houston at (281) 587-1111.

Baumgartner Law Firm

6711 Cypress Creek Pkwy, Houston, TX, 77069

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