You were involved in a bike accident in Plymouth, MA and you filed a personal injury claim successfully. However, while your Plymouth bike accident claim was in progress, your health insurance company paid for your medical bills and now that your claim has been settled, they want to be reimbursed. At this point, you are probably wondering why should you pay your insurer back?
First, your insurance contract most likely has a clause that states your insurer has a right to be reimbursed if you are injured by a third party and you recover monetary damages from that person. It doesn’t make sense that your health insurer should pay for injuries caused by someone else’s negligence.
Second, reimbursing your insurer prevents you from receiving a windfall. A windfall in this case is receiving compensation for medical expenses that your insurer and not you incurred.
The only problem with reimbursing your medical insurer is that you might not receive enough money to compensate you and reimburse them. So you should expect to haggle with them over reimbursement once your lawsuit concludes.
What Happens if You Don’t Get Full Value Compensation?
If you filed a lawsuit for a bike accident in Plymouth, there’s a high chance that you will not receive full compensation for your injuries. Why? Because the jury might decide not to award you for some of your injuries. For instance, they might decide not to award you for loss of consortium based on their perception of how your injuries affected the relationship between you and your spouse.
Secondly, the defendant might have a very low policy limit and it might not be enough to compensate you for your injuries. In this case there’s not much that you or your lawyer can do to ensure you are fully compensated by the defendant.
So what happens when you don’t get full compensation for your bike accident injuries? Do you still have to reimburse your health insurer 100%?
The good news is that you won’t have to. Common law states that a health insurer cannot be reimbursed if the plaintiff has not been “made whole” by the settlement. They should only be compensated up to the extent that your settlement exceeds the “make whole” amount.
So if you were to be made whole by $50, 000, you would only have to pay back your insurer if you receive more than $50, 000. If your health insurance is governed by the Employee Retirement Income Security Act (ERISA), then the “make whole” rule will apply. We say this because not all states have adopted the “make whole” rule.
You will know you have an ERISA insurance plan if it says so in the contract you signed with your insurer or if your employer provides insurance for you and they are not a government agency or a church.
You can always consult one of our Plymouth bike accident lawyers to find out which rules apply to “make whole”.
How Much Should You Pay Your Insurer Back?
We can always negotiate a fair amount that you can pay back your insurer. If you are not receiving full compensation, we can use this fact to negotiate. We can negotiate with your insurer to reduce the the reimbursement request to at least the same percentage as our attorney fee. We will also look for other facts that we can use to reduce the reimbursement amount even further. For example, if the defendant had a low policy limit and you had to take a low settlement because of this, we can use this fact to point out that you received far less than you deserved.
Your Bike Accident Lawyer Might Use an Interpleader
An interpleader will be involved if the insurer does not want to reach a reasonable settlement. Your lawyer might threaten to deposit the funds with the court and let the judge decide how the money will be split.
This is not a very good situation to be in because it means more work for your lawyer at no extra pay, your compensation will be delayed and the insurer might have to involve a lawyer at their own expense. Therefore, before you request your lawyer to use an interpleader, make sure the insurer is being completely unreasonable.