Q: Do I have to reimburse my health insurance company out of my personal injury settlement funds? Personal injury attorney Brian T. Allen offers an answer to this question as it relates to health insurance reimbursement claims.
A: Often times, after accident victims receive medical treatment for their injuries they receive a letter from their health insurance company asking for more information about the accident. This letter also usually contains a claim that the health insurer is entitled to reimbursement for the accident-related claims paid by the insurer. Such a reimbursement claim usually comes as a surprise to the injury victim and gives rise to the question, “Do I have to reimburse my health insurance company out of my injury settlement funds?” As is often the case, the answer to this question is, “It depends.”
The good news is that Arizona has strong constitutional and case law that health insurance policy reimbursement provisions are generally not enforceable. This “anti-subrogation” law was first recognized in the Arizona Supreme Court decision in Allstate v. Druke, 118 Ariz. 301 (1978) and has been upheld by the courts many times since. This means that even if the health insurance policy contains a reimbursement provision, the provision may not be enforceable. The bad news is that in a growing number of cases, Arizona law is trumped or preempted by a federal law called ERISA. ERISA provides that when it comes to certain self-funded, federally-qualifying employee benefit health plans, federal law allows enforcement of health insurance reimbursement provisions.
For the average person this means that if the accident victim has a premium-based health insurance policy, healthcare reimbursement claims are unenforceable in Arizona. But, if the victim has a self-funded health policy through the employer (usually large employers), the reimbursement claim will need to be considered. Keep in mind however that even ERISA plan reimbursement claims are often negotiable so it is always advisable to speak with an experienced attorney to discuss which law governs a particular claim.
If you or someone you know has a question about a health insurance reimbursement claim, call attorney Brian Allen at (480) 461-5335 or contact him at firstname.lastname@example.org for a free consultation to discuss your rights and options.
This blog is for informational purposes only. It does not create and attorney-client relationship and should not be construed as legal advice.