08192017Headline:

Vancouver, Washington

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Don Jacobs
Don Jacobs
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Health Insurance and Auto Accidents

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Although many consumers carry personal injury protection (PIP) coverage on their auto, the minimal limits sold in Oregon and Washington are $15,000 and $10,000 respectively.  If you require hospitalization after an accident, these benefits can be exhausted pretty quickly.  When this happens, some are fortunate enough to have purchased individual health insurance or have it available through an employer.  Although deductibles, co-pays and 80/20 percentages may apply depending on the particular coverage, most of these plans have high ceilings and cover medical bills up to a million dollars or more lifetime.  Unfortunately, an alarming trend seems to have taken hold in the last several years with these plans.  Provisions are being placed in the plans denying coverage for any medical care caused by an auto accident unless the consumer agrees to reimburse the plan out of any settlement or court award received.  Referred to as “subrogation clauses” these provisions have long been in the fine print of most plans.  The thinking is that when a consumer recovers the medical bills as part of a settlement or court award, they should rightfully reimburse their medical insurance company.   When challenged, the courts have upheld these clauses as long as the consumer was fully compensated on their claim.  If the guilty driver didn’t have enough insurance to cover the whole claim, the consumer had no obligation to repay his insurance company.  The courts have referred to this as the “made whole” doctrine, curtailing any reimbursement right of an insurance company unless the victim receives full compensation first.  Unfortunately, medical insurance companies may have found a way around this rule by forcing the consumer to sign documents waiving this right before they provide any coverage.   They reason if it wasn’t really covered in the first place, it really isn’t subject to the made “whole rule” rule.  The end result?  The insurance company gets paid first.  Which means perhaps your entire settlement or jury verdict goes to the insurance company and you recover nothing.  Makes you wonder why you bought insurance in the first place.