Recently, the Texas legislature passed a bill correcting inequities on subrogation rights on the part of certain health insurance and other entities. The action was needed to help protect Texas families who are involved in a serious injury accident through no fault of their own. Subrogation is where an insurer seeks to be repaid bills it has paid after an accident.
If you have questions about how much you need to repay your health insurance company after an injury from an auto accident, reach out to a good personal injury attorney.
The new law applies to certain health benefit plans that pay medical bills and expenses for people after an accident. Some time ago, Texas had a legal doctrine called the “make whole doctrine” which allowed injury victims some amount of equity when the insurance available to them after an accident was insufficient to cover medical expenses and also human damages such as pain and suffering or incapacity. Unfortunately, recent case law seriously limited the doctrine, putting Texas families is a very difficult spot after some accidents.
Previously, very seriously injured who had certain types of health coverage were hampered in efforts to settle their case because of the subrogation positions taken by certain insurers. In effect, the personal injury victim had little, if any, the incentive to settle when all the money would simply go back to the health insurance company that paid the bills, leaving the victim with little or no money as compensation for human damages such as physical impairment, disability or pain, and suffering or even for economic damages such as lost wages.
A personal injury lawyer can spend countless hours negotiating with health insurers to try to make a settlement work best for the victim. The law will aid everyone in setting a maximum amount that must be repaid in certain circumstances.
While the new law excludes worker’s compensation, Medicare, Medicaid, and self-funded ERISA plans, the statute will benefit a large number of Texas families who were unable to settle a case involving a very serious injury because of the subrogation issues. The statute, one effective, provides a framework to apportion recoveries with certain subrogation claims.
The law will reduce the number of lawsuits required to be filed because more claims will now be able to be settled. But perhaps the main benefit of the new statute is that personal injury victims who have been seriously injured and have very high medical bills will, in many cases, be able to settle their case without having to hire an attorney.
Prior to this law, that scenario was almost impossible for an accident victim with serious injuries and substantial medical subrogation to navigate. Texas families still need help when their health insurer refuses to pay medical bills after an accident, from hospitals that over-bill accident victims without health issuance and from allowing drunk drivers to benefit from Texas family’s personal responsibility in having health insurance.
The law amends the Civil Practice and Remedies Code Chapter 140.
If you have questions about a personal injury insurance claim, feel free to call Baumgartner Law Firm for a no-obligation consultation about your rights and options.