In personal injury cases, the medical bills are one of the most common damage categories. If a business or a person causes injury to someone, it is widely accepted that the business or person should be liable for all the medical bills that stem from the injury at minimum. However, the medical bills can give rise to an interesting question during the proceedings of the personal injury cases. What can happen when the health insurance firm has already given in money for medical bills stemming from the injury? If that is the case, would that result in the injured person getting two reimbursements for the same medical bill? Can the plaintiff sue the liable party for the medical bills? If not the case, must the responsible party be forced to pay for the harm caused?
This piece discusses the health insurance effects during the proceedings of the injury litigation.
Can the Liability Party be Sued for the Medical Bills paid by the Health Insurance?
The answer is simply yes. However, the plaintiff may not end up with the money. Let us consider an example of the contractor Jim to illustrate how it works.
Jim gets struck during the normal working hours by a moving earth mover that was in operation by another worker. Jim goes to the hospital with his health insurance. Jim’s shoulder is hurt along with other minor injuries that require surgery. For many months, Jim continued to get repeated surgeries as well as seeing a physician to get the shoulder strengthened. His health insurance policy pays over $50,000.
Jim files a litigation against the construction company after hiring a lawyer. The insurance company that covered Jim files a lien against that litigation. The health insurance firm, by filing the lien, argues that Jim was injured but received the medical bill payment. The company paid the medical bill. For this reason, the money received as reimbursement will go to the insurance company directly.
In most states, the lien from the health insurance firms is always valid. If Jim received $100,000 from the compensation for the lost wages, medical costs, and pain and suffering, the insurance company would take back $50,000 to have the rest remain for Jim and his attorney.
System Implications
When we analyze that situation carefully, the system has some sense. When we assume the construction company did the negligence, it would cost at least $50,000 according to Jim’s case. The healthcare provider for Jim paid $50,000. For this reason, the construction company should give back the money to the healthcare provider.
Let us consider some additions. Health insurance is in place to assist people to pay for health costs. Jim has paid his premiums to receive the money. For this reason, Jim has a claim to get all the money from this perspective. While the insurance company received that amount, it spent it because they collected Jim’s premiums for many years. In the real sense, Jim paid for his cost of medical care. Therefore, Jim should get the money directly.
On the contrary, the insurance company works by analyzing your case before they give out their money as to whether the claim is valid and they will receive their money back after the litigation is complete. If the law would have been different and all the money went to Jim, the insurance policy would charge higher amounts of money.
While the system is still the same, let us consider Jim’s case. He used more money taking the insurance company to litigation. Therefore, the plaintiff requires an incentive to file their claims.
Therefore, the main problem associated with the health care liens is that they can reduce the incentive for the injured person to litigation. Jim was injured. Therefore, he was responsible for filing the litigation. It would make more sense for the insurance company to get a lawyer to pursue the litigation. However, this is how the system works concerning personal injury cases.
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