My son and I were in an accident. We settled our claim and now the health insurance wants their money. That is fine I understand what they are trying to do but the adjuster said that I cannot negotiate my subrogation. I have to pay the full amount. Is that true? Does that mean I cannot talk them down? The lady is already rude and I asked to go over her head so I know that does not help. Will I be able to negotiate without a lawyer?
You negotiated your claim without an attorney, and without a fee, now you want to finalize matters without an attorney, and without a fee. You should rarely, if ever, proceed without an attorney. Sorry for being so direct.
Unfortunately, it appears that they do not want to compromise with you which is their right. An attorney would know not to settle the claim without squaring away the lien and using the leverage that they have. It probably was not a wise idea to settle the claim yourself. I hope that your son wasn't a minor.
Technically, your own statement make it clear that you did not "settle" your claim, since there are still unpaid parties out there that should have been dealt with.
You likely assumed more liability by releasing the best contributing party making whoever the insured is MORE liable. I suggest getting an Attorney as soon as possible. If you have insurance, THEY pay for your lawyer. Who knows what you are doing, but I would suggest you stop and step back... Additionally, this is just a general interest educational forum and not a place for "free" legal advice. Now it is educational, hopefully, for others to see you mistakes.... good luck.
You should have had a lawyer from the beginning. You likely would have settled your negligence claims for far more, and your lawyer would have likely obtained significant reductions in the subrogation claim too. Now you need a lawyer to fix the mess you created.
Did you receive notice of the subrogation claim from the health insurer before you settled? Even if you did not receive notice, subrogation language may be in the health insurance plan's language.
Did the released party's liability insurer receive notice of the subrogation claim before the settlement? If so, they might be asked to pay also. You might both owe it.
When you settled the negligence claims, you may also have signed a Release and Indemnity Agreement, releasing the responsible person(s) and their insurer, and also promising to defend and indemnify them from a subrogation claim. If they are sued, they will look to you to pay their legal fees and any amounts they pay to get out of the subrogation claim.
You would do well to hire a lawyer to evaluate this mess. If sounds like you are now helping the health insurer prove its case -- that you "converted" (stole) money, or bypassed their subrogation claim (breach of contract).
If you are sued, do not delay in hiring a lawyer to defend you. I recommend you hire a lawyer now to deal with the health insurer before you are are sued. If you intend to hire a lawyer, stop talking to the subrogation people.
If your son is an adult and he signed off n the settlement, he likely has similar problems. If he was a minor, then there are different problems.
Talk to lawyer ASAP.
Richard Kurt ArbucklePersonal Injury LawyerHouston, TX ·
Once you settled, you lost your leverage. If you had negotiated before the settlement you could have threatened to walk away and not cooperate (and the insurance would get nothing). Now that the case has been settled you can't do that. I doubt getting a lawyer would help at this point.
Joe Newman PerduePersonal Injury LawyerHouston, TX ·
You can try. Their subrogation rights are dictated by the contract's (health insurance) terms and certain statutory rights. Ask for the plan or the plan's summary. These are the terms. There are numerous issues that arise in contract/subrogation claims. Far too many to go through in a simple answer. Remember these people do not represent your interests. Thus the reason they can be rude. Good luck.
William Fulton BroemerEmployee Benefits LawyerHouston, TX ·
A health insurance company or benefits plan with subrogation rights relative to an injury settlement is not required to negotiate their subrogation interest in the claim. However, following the Supreme Court decision in Great-West Life v. Knudson (see link below), it has become very difficult for any insurer to collect a subrogation interest once the settlement or judgment funds have been distributed. While the insurer may refuse to negotiate, the insurer’s ability to actually collect the settlement proceeds from the insured may be very limited. This is often a strong incentive for insurers to negotiate reduced recoveries.
This is a very complex area of the law, usually falling under the Employee Retirement Income Security Act of 1974 (“ERISA”). ERISA is an extremely comprehensive and detailed statute. I strongly encourage you to consult with an experienced ERISA attorney and allow him/her to review your documentation and facts. Then the attorney will be able to give you direct, detailed advice.
Good luck.
Prior to January 1, 2014, the Fortis opinion issued by the Texas Supreme Court, allowed the health insurer to be reimbursed its full amount if that is what the health insurance agreement provided for in its terms. However, a new subrogation statute just went into effect in Texas on January 1, 2014 that likely affects the amount you owe. Depending on the type of health insurance policy you have, you may only owe a maximum of 50% of the amount paid by the health insurer. In hindsight, you should have retained an attorney to handle this matter for you. As others have pointed out, you likely would have received more money and he/she could have handled the subrogation issue. Good luck
