Legal Question in Personal Injury in California

In a personal injury accident can I still receive a big settlement if my hospital bills were paid by my medical insurance?


Asked on 10/22/14, 4:19 pm

4 Answers from Attorneys

Rob Reed Law Office of Robert A. Reed

This is like asking: "if I get the plastic surgery on my nose will Angelina Jolie date me?"

As to the issue at hand, nobody here can tell you whether you have a "big," small, or no settlement case based upon the information provided.

This being said, your health insurance carrier will have to be paid back from the proceeds of any settlement/judgment. And, because the health insurance company paid your bills (and presumably paid substantially less than asking price), a trier of fact will have to use the figures that your insurance paid and NOT the total amount of the original bill(s).

Hope this helps.

Good luck with Angelina.

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Answered on 10/22/14, 4:33 pm

Mr. Reed is right. I write to add that if your medical bills were substantial, your settlement could also be substantial. "General damages" which is what lawyers call the compensation for pain, suffering and other non-economic damages, are generally awarded or settled at somewhere between 2x an 5x special damages. Special damages are the medical bills (at the amounts actually paid as Mr. Reed said) and any other measurable economic damages, such as lost wages from time off work, damage to your car, etc.

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Answered on 10/22/14, 4:56 pm
Anthony Roach Law Office of Anthony A. Roach

To answer your question more directly, the fact that your health insurance paid medical bills does not deduct from the amount of damages you can recover in a personal injury action. In fact, there is a specific jury instruction that tells the jury not to take into account the fact that the parties have or had insurance.

Whether or not you have to reimburse the health care provider is not so clear cut as claimed by Mr. McCormick. That depends on the language of your policy and application of the "make whole rule" in California. A decent personal injury attorney should know about this area of law.

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Answered on 10/23/14, 10:15 am
Allister Liao Law Offices of Allister R. Liao

I think the question that you're asking is: "When my medical insurance company pays my medical bills, are the paid medical bills still counted in the damages calculation of my personal injury case?"

Answer: Yes, medical expenses paid by a medical insurer are still part of the damages equation.

Reasoning: The part of your settlement that's counted for paid medical bills probably will be returned to the medical insurer.

The medical insurer typically will have what's called a right to "subrogation." Get a copy of your health insurance policy and you'll find a contract clause that says right to subrogation, reimbursement, or some other similar wording.

If this language exists, then the medical insurer may have a right to get reimbursed from your settlement for what they paid for your medical expenses. That's why your settlement should take into account whatever medical expenses were paid -- even if paid by your medical insurance company.

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Answered on 10/23/14, 10:18 am


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