Health Insurance

If you have personal health insurance coverage purchased privately, provided through your employer, or provided through Medicare or Medicaid, you should always use this coverage to pay for medical needs. Health insurance is not fault based. Thus, whether you cause your own accident, suffer an accident caused by another, or simply fall ill and need medical assistance, health insurance pays for your medical care. We often see accident victims resist using their own health insurance when the accident was not their fault. This is a common and significant mistake! Health insurance protects your credit, provides immediate payment for medical needs, opens doors, and increases treatment options, and the use of health insurance will typically increase the net amount you collect from any personal injury settlement or verdict.

The laws governing health insurance carriers’ right to share in your settlement and collect reimbursement from your claims against an at-fault driver are constantly changing. Medicare and Medicaid always have a right of reimbursement. Your attorney should be able to significantly discount the health insurance carrier’s reimbursement lien by:

  • scrutinizing the Medicare or Medicaid lien to ensure that medical charges not related to the accident are removed from the reimbursement lien claim
  • timing the settlement and reimbursement properly so that Medicare or Medicaid can be paid early before their lien claim escalates—This converts coverage back to pure and allows you to seek future medical care without having to reimburse the health insurance carrier from your settlement proceeds.
  • by active and aggressive negotiation with Medicaid and Medicare’s legal representatives. All negotiated discounts are paid directly to the accident victim.

If your health insurance is purchased privately in North Carolina and governed purely by North Carolina law, the health insurance carrier will not have a right of reimbursement. In these cases, health insurance pays and you can collect again for those same expenses through medpay and through your claims against all liability insurance for all parties who caused your accident. The federal Affordable Care Act will limit these nonsubrogating health insurance policies, such that, after 2015, all health policies will have a right to some share of your injury claim proceeds.

Workers’ Compensation

If you are within the scope of employment when a car accident occurs, your employer must provide workers’ compensation benefits, which include full payment for all medical care costs, payment for lost income when work is missed for medical reasons, and lump-sum cash payments for permanent injuries. Workers’ comp also must pay to retrain you if you are unable to return to your previous line of work, and they also must provide modifications to your home and workplace when required for injury adaptation.

If you are eligible for workers’ compensation and the accident was not your fault, you are still allowed to present your personal injury claims against all at-fault drivers, their employers, and other responsible parties and insurance carriers. The workers’ compensation insurance carrier does have a right of reimbursement from your personal injury settlement/verdict. This amount can be negotiated down privately, and you also have the right to have the workers’ comp reimbursement lien claim discounted or waived through legal proceedings filed in the North Carolina state court system. Here, the judge determines the amount that the workers’ comp carrier receives from your injury claim proceeds.

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