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Auto Accidents, Medical Liens, Workers Compensation and Other Important Matters

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You have suffered injuries in an automobile collision through no fault of your own and have health insurance, medical payments coverage under your own insurance policy and your employer has workers compensation insurance. What do you do? Who should provide coverage for you in this time of loss? Should you submit healthcare expenses to your health insurance policy? Shouldn’t the responsible party’s insurance coverage provide sufficient protection for the losses incurred? What happens if you were working in the course and scope of employment at the time of the accident? Should worker’s compensation cover your expenses? The answers to these questions present some complex issues that require a comprehensive case-by-case analysis.

Because facts about available coverages in times of need vary so widely from case to case, I will not in this article give specific suggestions or legal advice about what to do in times of loss. Some health insurance plans have rights to reimbursement out of third-party auto insurance proceeds while others do not. Some healthcare providers have the right to attempt to recover the full amount of a medical bill from a third party and some should not have this right. Some providers should not seek recovery for medical care beyond what health insurance has already paid. Other providers will attempt to seek additional reimbursement out of third party auto insurance proceeds. Worker’s compensation carriers have the right to reimbursement out of third-party liability insurance proceeds depending upon nature and extent of third-party liability claims for injuries sustained in the course and scope of employment. If a worker’s compensation carrier pays claims to an employee in the course and scope of employment and the claims involve liability on the part of a third-party, then the applicable statute of limitations requiring a party to file suit or forever lose the right to pursue a claim against a third party changes to one year from what typically would be two years from the date of loss. Medical payments insurance providers in connection with your own personal auto insurance policy may also have the right to seek reimbursement from third party insurance proceeds for claims paid above a certain amount. Certain healthcare and auto insurance policies may even have different implications if they were written out of state.

Confused? Issues involving available coverage, reimbursement obligations and applicable statute of limitations generally require legal analysis after reviewing case-specific information and details. Fellow Scottsdale attorney Geoffrey M. Trachtenberg recently posted an article explaining why you should seek legal advise in times of loss and explains in more detail about some of these important issues:

While everyone knows to hire an attorney who is good at “getting a recovery,” few clients focus on hiring an attorney that is good at “keeping a recovery.” They just don’t know better. Most people don’t know that, when someone receives a settlement or verdict of any size, there are typically numerous entities that assert a right and priority to payment out of the recovery. That is, before a client sees a dime from any recovery, these multiple entities typically demand some (or all) of the recovery pursuant to various legal, contractual and equitable rights.

So if you suffer injuries based on the fault of another, consider seeking legal advice to assist in working through these complex issues.