Few people realize that, if you recover for your injuries under a personal injury or even workers’ compensation case, the insurance company that initially covered your medical expenses can assert a lien or “privilege” on any proceeds recovered. The subrogation definition describes the health insurance (or other) company being entitled to recover for what it pays for your care. Although it seems unfair—particularly when you have been paying a monthly premium for your insurance policy— a subrogation claim is typically a part of the contract that you agreed to.
It can be crucial to be aware of these issues, in part because hospital lien claims can be inflated and are not necessarily held to the same legal standards as health and other insurance companies. By understanding how and when a lien subrogation claim applies, you can better plan for it if you have to bring a case.
Louisiana Law – Subrogation Claim
Under Louisiana law, when compensation has been paid for an injury, sickness, or disease under circumstances involving a third party, the employee or his dependents may claim compensation. Similarly, a health care provider (including hospitals and ambulances) has a privilege out of the total recovered sum.
However, under the Louisiana Health Care Consumer Billing and Disclosure Protection Act, health care providers cannot bill a health insurance plan at the contracted rate and then bill the patient for the difference between the contracted and full rates. In other words, these companies cannot use a lien to collect an amount in excess of the contracted reimbursement rate for health care services. For example, if the health insurance company has negotiated for a particular service (such as a physical exam) to cost $100 when it would regularly cost $150, and the insurance company pays $75, the hospital can only charge you $25 and not $75. They cannot try to collect that extra amount from you or your settlement/case.
When it comes to severe auto accidents, these types of charges are magnified, meaning the difference is equal to thousands of dollars. Regardless, it is still crucial that insurance companies not try to double-collect, billing both the injured victim and seeking the extra amount from any personal injury settlements instead of abiding by the contracted price. In some states, this is called “balance billing.” Any violation of the statute provides you with a private right of action against the provider and insurer in Louisiana.
Our Personla Injury Lawyers Can Assist You Today
The personal injury attorneys at Harrell & Nowak have helped many victims in New Orleans, Kenner, Metairie, and throughout Louisiana obtain financial compensation for their injuries. Hiring a skilled attorney can help ensure that you are able to recover against other parties and negotiate with the relevant insurance companies so that you receive the total amount to do justice. Our accident lawyers will work to ensure that your rights are protected and that you receive a fair recovery if your injury has been caused by someone else not being responsible. Contact us today for a free consultation or to discuss a subrogation claim.
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