Do I have to reimburse my health insurance company if I settle my Massachusetts car accident case?

If you were injured in a car accident in Massachusetts that was caused by someone else’s negligence, you have the legal right to seek financial compensation from the other driver’s auto insurance company. Your health insurance company probably paid some of your medical bills for treatment related to your injuries after the Personal Injury Protection (PIP) benefits have been exhausted.

A lot of people don’t know that in a situation like this, your health insurance company may want to be repaid for the portion of the medical bills they covered for your treatment once your personal injury case is settled. If you have MassHealth or Medicare, then they are entitled by law to be reimbursed. A private health insurer will either place a lien on your personal injury case or send you notice of their claim for reimbursement.

I know what your thinking. If I pay for my health insurance, why do I need to repay them for medical treatment after a settlement. The rational for the health insurance company’s claim for reimbursement or lien is if another driver caused your injuries due to their negligent driving, then he or she (or their auto insurance company) is financially responsible to you for your medical bills, among other damages. So, if the other driver’s auto insurance company pays you a settlement, a portion of which is to compensate you for the medical bills you incurred as a result of the accident, then the health insurer wants to be repaid for the portion of the medical bills they paid on your behalf.

So, the general answer to this question is Yes, you usually must reimburse your health insurance company for the portion of the medical bills they paid if you are compensated for those medical bills. Now, I say “portion” of the medical bills, because the health insurance company doesn’t usually pay the full medical bills. They typically pay a percentage of the bill after they apply an insurance adjustment. Thus, if a doctor’s appointment costs $250, the health insurer may only pay $100 of the $250 medical bill. In this case, you should be reimbursed for the full medical bill of $250 from the negligent party, but will only need to repay your health insurer the $100. The balance of $150 left over is for you.

Also, don’t forget, most health insurance liens can be negotiated down. This is where an experienced Massachusetts personal injury attorney comes in. An experienced accident lawyer will know how to get your health insurance lien or repayment amount reduced. This will, in turn, result in more money for you from your settlement.

Speak With An Experienced Massachusetts Accident Attorney Today

If you were injured in an accident caused by someone else, and your health insurance company paid some of your medical bills, you should discuss your case with an experienced attorney in order to understand and protect your rights. Having an experienced attorney evaluate your accident case, may result in you collecting more money from any possible settlement.

Mahaney & Pappas, LLP has well over 40 years of combined experience helping accident victims get the compensation they deserve. If you have questions about an accident case, feel free to contact us online or call us at (508) 879-3500. We are happy to evaluate your case, answer your questions and explain how you can secure the financial compensation you deserve.