Health Insurance and ERISA regarding automobile accidents

Another type of insurance that sometimes is available to automobile accident victims is individual or group health insurance. Group health insurance is an insurance coverage that helps pay your medical expenses whether the expenses are caused by illness, disease, or the trauma of an automobile accident. In the case of an accident by a Florida resident who has a vehicle registered to them, their own "No Fault" insurance, of more specifically, their "PIP" coverage is "primary", or first in line to pay the medical expenses related to the automobile accident, and the group or individual health insurance is "secondary" or second in line to pay your accident related medical expenses only after PIP has paid what they were required to pay. It may be the 20% balance left after PIP pays the first 80% (if you don’t have "Med Pay") or it may be 80% or 100% of the medical bills that are incurred after PIP benefits are exhausted, i.e. PIP has paid the whole $10,000 policy limits and has no further obligation to pay anymore.

Group insurance is usually purchased through one’s employer and if so is governed by a federal law called ERISA (an acronym). ERISA requires that when someone else caused the need for those medical bills to be paid by your group insurance, your group insurance is entitled to be reimbursed by the at fault party.

Clients often wonder why, when they have paid a premium for their group insurance, they are required to pay back all that the group insurance paid on their behalf for injuries sustained in an automobile accident. In reality, the client isn’t really paying it back, it just seems that way, because the client sees the amount being deducted from any gross settlement received at the end of the case paid by at fault party’s insurance.

Here’s the real logic behind it: You are involved in an accident that is not your fault, your group insurance ends up paying some of your medical bills. Your group insurance would not have incurred this "loss" or made these payments, but for the negligence of the at fault party who caused the accident. Therefore, your group insurance shouldn’t have to suffer a loss, the at fault party should instead. So when negotiations are made to settle your claim, a part of what is being asked for in settlement is the money to repay whatever your group insurance paid on your behalf in relation to this accident. Therefore, because the at fault party is repaying them as part of your settlement, you will see that amount getting deducted from your settlement amount making it appear, at first blush, that you are repaying the group insurance, but in reality, you are just passing the money along to the party for whom it was meant, i.e. your group insurance carrier. The law gives the group insurance carrier an actual lien on your settlement to ensure that you pass that money along, and you will want your lawyer to make sure the lien is paid out of the settlement as required by law. To make sure any lien on your settlement is paid by the proper party, be sure to hire the Higgins Law, LLC to get that lien paid.

Medicare and Medicaid also have liens, and must be repaid just like your group insurance does. One of the important reasons you need a competent lawyer to handle your automobile accident claim is to make sure liens get paid. Please call Higgins Law, LLC to ensure that any ERISA liens on your case are paid out of settlement.