Read the fine print in your health insurance...

[MrsNormanMaine[$]]

Another glaring example of the difference between what is right and what is legal. This one involves Wal-Mart but it could be your employer next...

Dr. MNM

Wal-Mart sues injured employee for settlement money

[mjfrombuffalo[$]]

The reason is a clause in Wal-Mart's health plan that Mrs. Shank didn't notice when she started stocking shelves at a nearby store eight years ago. Like most company health plans, Wal-Mart's reserves the right to recoup the medical expenses it paid for someone's treatment if the person also collects damages in an injury suit.

Most of the plans I've been in have that stipulation too. That's probably where the "was this the result of an accident" checkbox on the insurance claim form comes from...

[pippadaisy[$]]

OMFG.

But it's in the best interest of the other subscribers to have the CEO of the health care organization making millions each year? And for them to pay for advertising all over the place? Including plastering their name on arenas?

[slick4591[$]]

You'll find subrogation clauses in probably every insurance policy written. I used to have to get insurance information from victims to make sure the insurance company got paid any restitution ordered first. The victims deductable was paid last because of the way the policies were written.

[frazzledspice]

Like most company health plans, Wal-Mart's reserves the right to recoup the medical expenses it paid for someone's treatment if the person also collects damages in an injury suit.

And if a seriously injured person goes on Medicaid, the government will demand reimbursement from the proceeds of a lawsuit, too.....

The fault really lies with the jury. When they were trying to determine economic damages, they should have taken into consideration all the medical expenses she'd incurred before deciding on what she needed to cope with her disability for the rest of her life.

[pippadaisy[$]]

I think that you are going to see a lot more lawyers bringing up the subrogation charges to the juries when they come up with their estimates.

[amykhar]

In PA, if you get hurt in a car accident, they will NOT bill your health insurance. They want your car insurance information. Even if your kid is hit on the street by another driver.

And, when Hossam was killed, workman's comp got a chunk of the insurance settlement the kids received from the drunk's auto insurance too.

My lawyer told me right up front that this was going to happen, and negotiated a fair settlement with the workman's comp people.

Amy

[emeleel]

Workman's comp?

[amykhar]

Hossam was working when he was killed.

[emeleel]

Ah.

[theworm[$]]

why did workman's comp get a claim on the money? Did they pay out medical expenses after the accident?

[amykhar]

No. They pay a small sum each week for the kids.

[emeleel]

Wouldn't it be easier just to leave the settlement alone and forget about the weekly sum?

Or would that be too simple?

[amykhar]

Nope. In this case, they only took a fraction of the settlement and still pay each week until Kareem gets out of college. So, it's better for us this way. The driver didn't have more than the minimum insurance, and Hossam wasn't insured for underinsured driver.

[realtraveller]

The trucking company that hit her had only $1,000,000 in insurance coverage?
That's completely insufficient. If the trucking company had assets in addition to the insurance coverage, the lawyer should have gone after them also, but that's much more difficult and lawyers like to go after the low-hanging fruit, which is the insurance policy.

[slick4591[$]]

pippadaisy said

I think that you are going to see a lot more lawyers bringing up the subrogation charges to the juries when they come up with their estimates.

Don't know about other states but here you can't bring up any settlements with insurance companies during trial. That means a victim could be paid twice.

[emeleel]

But if the jury understands when a person is going to be *required* to pay back what they've already received from another source, then they can award a proper amount that will cover both that plus whatever they need for the future. If I thought someone deserved $100,000 for their injuries, but had no idea that they were going to have to pay back $50,000 to the insurance, workman's comp or whatever, then that's hardly fair - they're only going to end up with $50,000, not the $100K the jury *thought* they were awarding. Or perhaps it could be done as "$100K plus whatever they will need to repay" without anyone on the jury needing to know what that number happens to be.

[realtraveller]

Well, the attorney might have been able to structure the settlement so that a certain amount went for lost future wages and pain and suffering rather than to medical costs, but you couldn't structure the settlement to in effect try and defeat (or defraud) WalMart. Look, WalMart, paid all the medical bills, not this woman.

The unanswered question in the story is why a woman as severely injured as this one, got only $700,000 in the settlement (and it sounds like a settlement, no jury award). She didn't even get the full amount of the trucking companies paltry $1,000,000 policy. My guess is that she was partly at fault in the accident and that accounts for the lower payout.

[Helen_B[$]]

The settlement was pitifully small, especially so since WalMart gets a chunk of money back. It is inconceivably expensive to give quality care to a person who has been injured so badly, or who needs round the clock care because of age or infirmity. That's got to be why insurance companies are selling chronic care policies, to pay for this kind of care that we all hope we will never need.

At my mother's assisted living building, I know there are people who would be in a nursing home if not for a spouse living with them to listen for them at night, help them dress, do the laundry, arrange medical appointments, wrestle with the wheelchair to go to dinner, etc. etc. These little old people should not have to be taking care of themselves, but there is no coverage for home care.

[jgibson2[$]]

Kathy,
Attorney fees. 30% is pretty low, BTW.

[realtraveller]

jgibson2 said

Kathy,
Attorney fees. 30% is pretty low, BTW.

I read the article again. She got $700,000 but netted $417,000 after legal fees. Mr. got $200,000 and netted $119,000 after legal fees.

So together they got $900,000. from the trucking company.

Given the damage that trucks can do, states should require trucking companies to carry larger insurance policies.

[mjfrombuffalo[$]]

On the flip side, say you worked for a company that offers insurance benefits, but the costs to the company (and to you) have been going up. Say a coworker (let's make it someone you didn't know, someone at a remote field office) was hit by a drunk driver or shot by Dick Cheyney during a hunting trip or a something-not-related-to-work accident.

Would you want the insurance company to recoup money from the driver/hunter/other responsible party (directly or indirectly through a settlement), or would you want your insurance costs to go up over something that some outside party was responsible for?

[pippadaisy[$]]

Again, considering that insurance prices are based on the idea that the majority of people don't use what they pay in, and considering that the CEOs of said insurance companies are making millions of dollars a year? I don't expect co-workers to pay back. I'd NEVER expect someone to have to pay that back. That's why we PAY FOR INSURANCE. When the insurance companies' CEOs start living on the same salary that the average Joe makes? You can ask me again.