You've fought hard for your settlement. You finally get the offer you deserve. But then your lawyer tells you that your health insurance company wants a chunk of it. This is called 'subrogation.' I...
You've fought hard for your settlement. You finally get the offer you deserve. But then your lawyer tells you that your health insurance company wants a chunk of it. This is called 'subrogation.' It feels unfair—you paid your premiums, why should you pay them back? Understanding subrogation is essential because it directly impacts the net amount of money you walk away with.
The Basic Concept
Subrogation is the legal right of an insurance company to claim reimbursement for payments they made on your behalf if a third party is found responsible for the loss. Essentially, your health insurer says, 'We paid for your surgery because that other driver hit you. Since that driver is now paying you for the surgery, you need to pay us back.'
Who Can Claim Subrogation?
Private health insurers, Medicare, Medicaid, and workers' compensation carriers all have subrogation rights. However, PIP insurers generally do NOT have a right to subrogation in Florida, which is a key benefit of the no-fault system.
The 'Made Whole' Doctrine
Florida has a consumer-friendly rule called the 'Made Whole Doctrine.' It states that an insurer cannot take money from your settlement until YOU have been fully compensated for all your damages. If your settlement is small compared to your injuries (limited policy limits), we can often argue that subrogation should be waived or drastically reduced.
Negotiating the Lien
Subrogation claims are negotiable. We review the itemized list of charges to ensure they are actually related to the accident. We also argue for reductions based on your attorney fees (why should they get 100% back when you had to pay a lawyer to get the money?). We often save clients thousands by fighting these liens.
ERISA Plans
Some employer-sponsored health plans (ERISA plans) fall under federal law, which overrides Florida's friendly state laws. These plans are tougher to negotiate with, but an experienced attorney knows the specific strategies to handle them.
Contact Emas Law Group Today
Subrogation is complex, but it shouldn't be a surprise. At Emas Law Group, we identify potential liens early and develop a strategy to minimize them. Our job isn't done until we've maximized the money that stays in your pocket.
Frequently Asked Questions
Do I have to pay back Medicare?
Yes. Medicare has very strong recovery rights. We handle the reporting and negotiation process with the Centers for Medicare & Medicaid Services (CMS).
What if I don't pay them back?
They can sue you, garnish your wages, or cut off your future benefits. It is never worth ignoring a subrogation claim.
Does my lawyer get paid from the subrogation amount?
No. We calculate our fee based on the total settlement, and then we pay the liens from the client's share. However, we work to reduce the lien so your share is larger.