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What does it mean that I am to be "made whole" before my medical insurer is repaid out of my injury settlement?
Anonymous2 views4 answers
I have received extensive medical care due to an auto accident. The driver found at fault didnt have a high enough policy to cover my bills so we are now filing a claim against my own insurance. I'm now told that my health ins company will request reimbursement, but WA state law says I have to be "made whole" before they are repaid. What does that mean? My medical bills, according to my medical insurer, are nearing 3/4 of my policy limit to date and I'm being told I still require extensive treatment. I could use the $$ as I cannot work like this, but if I have to pay atty fees and reimburse them as of now I would net less than 10K for injuries that will effect the rest of my life.
What exactly does it mean that I am to be made whole?
Made whole can have different meanings. In general it means you are fully compensated for your case. There is no real way to determine if anyone is really made whole. We may all disagree on what your damages or case is worth. A personal injury attorney in WA can work with you to get your bills or subrogation reduced. With a very serious injury, and limited insurance, we probably could agree that you are not made whole. Certain injuries and even wages can make it difficult to determine if you are made whole. When there is a insurance policy and you settle for less than the limits, your insurance can argue you agreed you were made whole by accepting less than the policy limits. I think you are clearly not made whole by the others insurance. The issue is are you made whole by your underinsured insurance limits. Some health insurance companies do not subrogate against underinsured insurance. The underinsured laws in your state are also an issue. If you have an attorney, take their advise. If not, get a WA attorney.
The information provided on this website is for general information purposes only. The attorney is licensed in the State of Alabama. No answers or information on this site should be taken as legal advice for any individual case or situation. This information does not create an attorney-client relationship.
Robert Daniel KellyPersonal Injury LawyerSeattle, WA ·
You have a right to full recovery and reimbursement before the insurance companies subrogation claims can be effective. THIRINGER v. AMERICAN MOTORS INS., 91 Wn.2d 215, 588 P.2d 191 (1978). http://www.mrsc.org/wa/courts/index_dtSearch.html. Your financial recovery should include payment of all past and future medical bills, lost wages, property damage, pain, suffering, emotional distress, loss of enjoyment of life, etc.
[In accordance with community guidelines, this communication does not constitute “legal advice”, nor does it form an attorney-client relationship.]
One other consideration is whether your health insurance plan is an ERISA plan or not. Many ERISA plans claim that they are not goverened by the "made whole" doctrine and may seek 100% reimbursement without any reduction for attorney's fees or costs. An experienced attorney can help you through this and you should first discuss with your attorney.
