Legal Question in Personal Injury in California
Can My HMO recover from nonmedical damages?
I have been offered a small settlement in a minor accident. I know that my HMO has contacted the company for reimbursement. Can my HMO recover their expenses from the portion of the settlement allocated for ''pain and suffering''?
2 Answers from Attorneys
Re: Can My HMO recover from nonmedical damages?
When you state "company," in your question, I assume that you are referring to the insurance company.
Your HMO probably has a provision hidden away in small print somewhere near the last page of your contract with them, that states it has a right to reimbursement for any funds it pays towards a personal injury claims stemming from an accident. So to answer your question, it is possible that they may seek reimbursement from you.
Good luck.
Re: Can My HMO recover from nonmedical damages?
Most likely, they can be reimbursed for money they paid for your medical bills. This is sometimes called a right of reimbursement. It means the HMO, or the insurance company, can recover for medical services they paid for if you recover from the at fault party.
In order to analyze this, you need a copy of your plan. If the settlement is not including all of your medical bills, you may be able to argue to the insurance company that they should not be reimbursed in full either.
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