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Understanding Subrogation Actions


Subrogation claims or actions are typically brought by your health insurance provider after you receive a settlement or judgment in your personal injury claim. If your health insurance provider paid your medical expenses before your settlement or judgment, they may be allowed to collect a portion of your settlement or judgment to cover their expenses paid out for your medical bills. However, there are limits to what health insurance companies can claim and there are ways in which you can reduce the amount insurance companies can take from your settlement.

When you have been injured in a car accident or some other traumatic event, you are likely to have significant expenses. These are not just medical expenses or costs related to hospital visits or treatment. If you are going through a difficult injury recovery, you are likely losing income. There are also a number of routine expenses from mortgage and car payments to the cost of utilities and other services. When you lose money as part of a subrogation claim, it can deal a significant blow to your financial situation, particularly if you are already struggling to make ends meet.

This is why it is important to contact an experienced Orange County personal injury lawyer who can not only help you better understand the subrogation process, but can also help reduce the amount of a subrogation claim so you receive maximum compensation for your damages and losses.

Why It's Important to Read the Fine Print

The first step is to obtain a copy of your health insurance plan policy. You will be able to request a copy from your plan administrator. To understand what rights your health insurance carrier may assert, it is crucial that you read the entire policy. Does the policy contain language that authorizes subrogation? Under federal law, if the policy does not contain this language, the carrier may be unable to assert a claim against your settlement.

However, each health insurance policy has a subrogation clause. This is a fact whether you have Medicare or Medi-Cal or a private insurance carrier. Not everyone takes the time to carefully read each detail in his or her health insurance policy. But, rest assured, the subrogation clause is a part of your health insurance policy. It's in there.

So, when does subrogation come into play? It typically occurs when a third party pays for medical claims as part of a settlement or judgment in a personal injury case. For example, in a car accident, when you get a settlement check from the auto insurance company of the person who caused the accident, that is referred to as the "third party." In such cases, the subrogation clause of your health insurance would come into play and you would be required to give some of your settlement to the insurance company. 

Limitations of Subrogation

If you have received money directly from the party that has injured you, it is unlikely that subrogation will come into play. This may be important particularly in cases where the injured party is self-insured. If the money you receive comes from your own insurance as part of an uninsured or underinsured motorist compensation, for example, your health insurance company may not claim subrogation in most cases. It is important to know whether the money you are receiving is coming from a third-party insurer or directly from the person who caused your accident or is deemed at fault for your accident. 

It is also important to understand that your health insurance company cannot take away everything that you receive in the settlement as part of subrogation. Under California law, the amount an insurance company can claim as part of subrogation is limited. The law in California limits subrogation to no more than one-third of your total settlement if you engaged an attorney or one-half of your settlement without an attorney. This law is meant to protect injured victims from situations where they may end up getting nothing after subrogation. 

Can You Reduce the Impact of Subrogation?

An experienced Orange County personal injury lawyer may be able to negotiate with your health insurance company to reduce the amount they are claiming by subrogation. Attorneys have significant experience handling these situations and negotiating with insurance companies. Therefore, when you engage an attorney to fight on your behalf, there is a higher likelihood of getting better results rather than attempting to negotiate the subrogation on your own.

One way to minimize the amount of subrogation is to make sure that the medical expenses being claimed are only those that were generated by your accident. Your personal injury attorney can work to obtain a detailed account of all the medical bills that are being claimed as part of the subrogation. You can then remove any bills of expenses that are not part of your accident claim. 

You may also be able to request that the injury attorney's fees be subtracted from the subrogation claim. The fact remains that had you not retained the services of a personal injury lawyer, you may not have received the settlement or judgment that you did receive. So, it is only fair that the attorney's fees are removed from the subrogation claim.

Why You Need an Experienced PI Attorney

Since this can be a complex and involved process, it might be in your best interest to retain the services of an experienced Orange County personal injury attorney who is a skilled negotiator and has the ability to get the insurance company to significantly reduce the amount of their subrogation claim. The more experienced your attorney is at negotiating such claims, the more likely they are likely to be successful in getting the claim reduced. 

The experienced Huntington Beach personal injury lawyers at Timothy J Ryan & Associates understand the hardships that individuals and families face as a result of suffering a serious personal injury. We have a long and successful track record of fighting for the rights of our injured clients and helping them secure maximum compensation for their losses. We work on a contingency fee basis, which means we don't get paid unless you receive compensation. Call us at 714-898-4444 for a free consultation and comprehensive case evaluation.


Get The Help You Need With a Free Consultation

Speak with a personal injury attorney near you. Call (714) 898-4444 or fill out the form to obtain your free, no-obligation consultation from attorney Timothy J. Ryan. Tim has helped California injury victims obtain more than $1 Billion in compensation since 1981. Get your questions answered today.