If you have a personal injury claim in Oregon or Washington, and a health plan or health insurance policy is paying your medical bills, you will probably have to pay back your health plan out of any personal injury settlement you may recover. How much depends on the health plan.
In auto injury cases, people who are injured in a car that was insured in the State of Oregon will have personal injury protection benefits, which provide medical insurance for injury related treatment up to a certain amount, and over a certain period of time. In Washington, personal injury protection coverage is optional, so you may or may not have this coverage available to paymedical expenses.
If you suffer a serious injury, you are probably going to use all of the available personal injury protection coverage, which means that you will have to look to your health plan to cover the remainder of your care. If your automobile policy was originated in Washington, you may not have personal injury protection coverage, and you will have to have your health care plan pay all of your medical bills. In either case, you will probably have to reimburse your health plan for the medical bills it paid out of your personal injury settlement. How much depends on the health plan, and the circumstances of your case.
Most private health insurance is not actually "insurance" in the legal sense. Instead, it is a "health plan," which is regulated by federal law. The federal law that regulates these plans allows the insurance carrier a lot of leeway in what it can include in the plan. Most health plans will exclude payment of any medical expenses that are responsibility of some other party, like a careless driver who injures you in an auto collision. However, these health plans will pay for accident related medical care, but only if you agree to reimburse the health plan out of any money that you obtain in a personal injury settlement.
The amount that you have to pay back depends on the plan's language. Some plans will only pay up to a certain amount for accident related care. Other plans will pay for all care, but the plan may require that you pay 100% of the medical benefits it provided. Other plans will negotiate a discounted reimbursement, realizing that many cases, you may have had to hire an attorney to help you with the case. In other words, the plan is agreeing to share in the cost of paying the attorney.
When you have been involved in a serious injury, it is important to know exactly what the terms of the health plan are so that you can plan ahead.
We deal with issues involving personal injury claims and reimbursing health plans when there is a personal injury settlement or recovery. If you have questions about your options with a personal injury claim and your health plan, call us at 503-325-8600. We deal these issues every day.