Legal Question in Personal Injury in Georgia
medical reimbursement from auto accident
My wife and son were in an accident at the first of this year. We have received an offer from the insurance agency, but before we accept, we are trying to figure out how medical is to be paid back. IF the medical bills were filed/paid through my personal health insurance and that $ amount has already been subtracted from my lifetime max, do I have to give the doctor's office all the money that they sent to the auto insurance? Would they not be double-collecting? The doctor's office will not give me a copy of the medical bills they sent to the auto insurance carrier ( Some office policy), but we have EOBs showing that my health insurance has paid them. Where do we stand?
4 Answers from Attorneys
Re: medical reimbursement from auto accident
My colleagues are all correct, the language of your policy, whether your policy is an ERISA plan, whether your wife and son are fully compensated, that is "made whole," are all important issues as relates to the reimbursement claim of your healthcare insurance provider. More critical than that, however, is the issue of whether your settlement is adequate.
To the extent you have already negotiated, there may be a psychological barrier to negotiating a better deal, even for your attorney. You can rest assured, if you have done the negotiations yourself, it is highly likely you have obtained an offer far below the value of their claims.
Because claims of this nature are handled on a contingency basis, you can expect to be able to review this matter with an attorney who specializes in personal injury claims on a free consultation basis.
If you wish to discuss this matter further, please call.
Jim Hough
770-607-8488
Re: medical reimbursement from auto accident
You should contact a local attorney to review your health insurance policy. The language in the policy will control. Also, if I were involved, I would want to check into your doctor's unwillingness to provide you with copies of your bills. If you would like to give me a call to discuss, please feel free to do so.
Re: medical reimbursement from auto accident
Let me state first of all it was and is very unwise to negotiate without a lawyer. It is very possible that even after paying attorneys fees out of a settlement, you would do better with a lawyer. I encourage you to call us or some lawyer before speaking again to the insurer.
You may be making a mistake otherwise.
As for issues of when and if insurance payments must be repaid and what medical bills are to be paid, that depends on many things, including whether the settlement makes you whole and whether it is an ERISA plan. Again this is a reason you need experienced counsel.
Your doctor should give you your own bills. It is unethical for a doctor to refuse to do so. A lawyer will know how to obtain the bills and medical records and those need to be reviewed before there is a settlement.
If we can be of assistance, please feel free to call me at 404-768-3509.
Let me add that there are strict time limits for these type claims. If you let them expire, you will lose all chance of recovery so time is very critical in these cases.
Re: medical reimbursement from auto accident
The answer depends on the language of the policy. I would be suspicious of any doctor who does not give you copies of your medical bills, regardless of how or whether they are paid.
If you would like to discuss any issues further, please feel free to contact my office. My contact information is below. Thank you.
The foregoing is general information only, not specific legal advice. No attorney/client relation has been created or should be implied.
Glenn M. Lyon, Esq
MacGregor Lyon, LLC
Promenade II
1230 Peachtree Street NE
Suite 1900
Atlanta Georgia 30309
Phone 404.942.3545
Fax 404.795.0993
www.macgregorlyon.com
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