Accidents happen, and if they are someone else's fault, you can go to court to try to get compensation for your medical expenses, lost wages and pain and suffering. If you win, though, the pot of gold you receive may be considerably smaller than you expect. Your health plan may claim some — or all — of the award as reimbursement for money it spent on your medical care.
That is completely legal and it happens all the time. But a recent U.S. Supreme Courtdecision gives consumers ammunition to push back against the health plan.
The basic facts of the case are common: In December 2008, a drunken driver ran a stop sign and hit Robert Montanile, seriously injuring him. Montanile had lumbar spinal fusion surgery and other medical treatment that cost $121,044 and was paid for by his health plan — the National Elevator Industry Health Benefit Plan. Montanile sued the drunken driver and won a settlement of $500,000. He paid his attorneys $263,788 in fees and expenses, leaving him $236,212.
Montanile's health plan claimed it was entitled to be reimbursed for his medical care.
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It should be the insurance companies suing the other party for compensation. This is just a way for the insurer to NOT have to pay any fees to collect monies they may be do, the let the insured party pay all legal fees. Maybe the insured should sue the insurer for part of their legal expense used to collect the money the insurance companies want!
ReplyDeleteI'm no lawyer, but I totally disagree with the courts here. The insurance provider has made a contract with the rate payers, who collectively contribute to the insurer's fund, which is used from in case an accident happens to one of the rate payers. It is required of the insurer to pay out for the medical bills just as it is required that the rate payers keep up with the weekly payments. It's a closed contract.
ReplyDeleteIf the Insurer feels like the at fault driver had caused over the top damages beyond some type of norm, then they should sue the at fault driver separately, not the rate payer. But unless the policy was written with clear limits of coverage, I can't see how they could be awarded anything.
Just my 2 cents worth.
To get food stamps you do absolutely nothing. When you Dont have them either they think you make too much. What's the big deal with her asking for them. If that's what she wants to do with her money then that's good. If others could do it, they would do it to. There's away around everything even if the person goes to the store and get your groceries for you. If you that mad, ask one of your friends can you buy some too.
ReplyDeleteI'd like to see a ruling that says attorneys can't walk away with 50% of the proceeds.
ReplyDelete