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What does it mean when my health insurance company says they have a 'right of subrogation?'


A: When you go to the doctor or hospital for injuries you received from an accident or malpractice, in all likelihood your health insurance company will be paying your medical bills. [This does not include car accidents, where your no-fault insurance company will be paying for your medical bills up to a certain dollar limit.] If you continue to receive medical care for your injuries and those bills are paid by your health insurance company, then your health insurance company has a right to recover those monies that they paid for your medical care. Why? Because your injuries were caused by someone else. If you bring a lawsuit claiming pain and suffering and also that you incurred medical bills and you get money for your injuries- your health insurance company wants to be repaid. Technically, your health insurer 'steps into your shoes' and can bring a claim against the insurance company of the person or hospital who caused you harm. They can obtain their money directly from them. Alternatively, the health insurance company can bring a claim against you, the injured victim saying that since you settled your case, you are obligated to repay us for what we already paid out to your doctors. This is the 'right of subrogation'. It appears in very small fine print in most every health insurance policy in New York. Some policies are very specific and say, "If you bring a lawsuit to recover money for your injuries, and we have paid for your medical bills, we have a contractual right to be repaid." The Courts in New York have consistently permitted health insurance companies to intervene in pending injury lawsuits to allow the health insurer to recover money that they already paid. For more information about this, or to read the actual cases discussing the right of subrogation, please call me.