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Vancouver, Washington

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Don Jacobs
Don Jacobs
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Insurance Settlements and Health Care Bills

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Read the fine print. Who hasn’t heard that advice. Let’s say you are injured in a collision. The other driver is at fault. Fortunately, they have insurance. You’d think the company would step up from the very beginning and offer to pay your medical bills as they are incurred. Wouldn’t that be the right thing to do? Wouldn’t you want your insurance company to do this if you injured someone? I’m not saying this never happens, but in over twenty five years of doing accident law I’ve seen it occur twice. This makes it almost as rare as a Trail Blazer Championship. So how do you keep the doctors off your back while you’re waiting to settle? Most people turn to the PIP coverage on their auto policy. This is great coverage, but many people make the mistake of buying the lowest coverage available, $15,000 in Oregon. This amount can get eaten up pretty quick if you are hospitalized, especially if expensive tests are run. Then what? To whom do you turn? What about your health insurance? You may have a deductible and some co-pays, but at least the bulk of the bill will be paid. However, just about every health insurance policy these days has a provision saying they get paid back when you settle. Some consumers wonder why they have to pay this back, since they’ve been paying for years to maintain the coverage. The short answer is it’s in the policy. You didn’t have much choice about the terms when your company went with this health insurer. Well that’s fine you figure, after all the settlement should cover all my health care bills and usually a bigger amount for pain and suffering. But what if it doesn’t? What if the other driver purchased the lowest coverage allowed by law? What if the coverage isn’t enough to cover all of your bills? Who gets paid first, you or your health insurance company? Well gosh you were the person who was injured. You were the person who paid for the health insurance coverage out of your check every month. Clearly it must be you, right? Think again. Read the fine print. Many health insurance policies now have provisions giving them the right to be paid first. Many are now actually contacting the other driver’s insurance before the case settles, demanding they be paid in full before you get a dime. Liens are threatened unless they are paid directly, sometimes leaving you with nothing. What about all those co-pays and deductibles you had to pay? What about your lost wages? Shouldn’t they be paid first? Before your insurance company gets any money? Seems reasonable. But insurance companies carry much more clout than the average consumer. They get to write the contracts. There are a few protections in the law limiting your health insurer from taking all the money. But don’t expect them to tell you when they apply. After all, who is more important here, you or the insurance company?