When Is Your Health Insurance Entitled to Claim Subrogation?

If you have health insurance, you may be wondering what subrogation is and when your insurance company is entitled to claim it. Subrogation is the right of an insurance company to seek reimbursement from a third party who is responsible for causing an injury or illness. In other words, if your health insurance pays for your medical expenses, the insurance company may have the right to pursue the person or entity that caused your injury or illness for reimbursement.

How Does Subrogation Work?

When you file a claim with your health insurance company, the insurance company will investigate the cause of your injury or illness. If the insurance company determines that a third party is responsible for causing your injury or illness, the insurance company may file a subrogation claim against that third party. If the insurance company is successful in its subrogation claim, it will be reimbursed for the medical expenses it paid on your behalf.

When Is My Insurance Entitled to Claim Subrogation?

Your health insurance company is entitled to claim subrogation if a third party is responsible for causing your injury or illness. This can include:

Car accidents: If you are injured in a car accident, your health insurance company may be entitled to subrogation from the at-fault driver’s insurance company.
Slip and falls: If you slip and fall on someone else’s property, your health insurance company may be entitled to subrogation from the property owner’s insurance company.
Medical malpractice: If you are injured due to the negligence of a doctor or other healthcare provider, your health insurance company may be entitled to subrogation from the healthcare provider’s insurance company.

What Are My Options if My Insurance Company Files a Subrogation Claim?

If your health insurance company files a subrogation claim, you have several options. You can:

Cooperate with the insurance company: You can cooperate with the insurance company by providing them with information about the third party who caused your injury or illness. The insurance company will use this information to pursue its subrogation claim.
Hire an attorney: You can hire an attorney to represent you in the subrogation claim. An attorney can help you to negotiate with the insurance company and protect your rights.
Do nothing: You can choose to do nothing and allow the insurance company to pursue its subrogation claim on its own. However, this is not recommended, as the insurance company may be able to recover more money if you do not cooperate.

If you are injured due to the negligence of a third party, it is important to understand your rights and options under your health insurance policy. If your insurance company files a subrogation claim, you should carefully consider your options and make the decision that is best for you.