Legal Question in Insurance Law in Pennsylvania

Re: Insurance Subrogation

The basic issue is whether or not the health insurance policy is a policy issued under a federal law known as ERISA. Under PA law, the health insurer is not entitled to seek reimbursement for an auto claim like you son had. However, under the ERISA law, a health insurer may be entitled to reimbursement, if the health ins policy provides for reimbursement. Most health ins policies issued by large employers are controlled by the ERISA law. Most attorneys who handle accident cases are familiar with these issues, so you should consult with the attorney who handled your son's claim. There are also issues whether you or your son is liable to reimburse the health insurer. Good luck!!

Re: Insurance Subrogation

The question is did the insurance comapany (health) notify you or your sons attorney prior to the settlement of the claim. If not there should be no liability on you or your sons part. If they did an attorney would need to review the documentation and relevent policies to determine if money is owed. Finally, your sons attorney if he was notified may have had the insurance company make a direct payment to the health insurance company. I offer free consultations.

Re: Insurance Subrogation

Insurance premiums do pay for insured losses but under some health insurance policies and under some circumstances, the insurer may recover medical expenses paid on behalf of the victim out of the victim's settlement with the tortfeasor. This is sometimes known as the insurer asserting a subrogation lien. Not all insurance policies provide the insurer with this right, and in some circumstances the insurer has no such right even if the policy purports to grant lien rights. When the insurer may have a valid claim against settlement proceeds, the insurer's claim should be dealt with as part of settling with the tortfeasor. Where the settlement took place without considering the health insurer's claim, the situation can become complicated. If the settlement is being paid in installments, another layer of complexity is added. You should consult with your attorney from the original settlement and get advice on whether the health insurer has a valid claim and if so, why the insurer's claim was not dealt with at the time of settlement. You have not stated how long ago the settlement took place, but the passage of time can be extremely important to you. You have also not stated how much money the insurance company is claiming, which can also be very important. If your original attorney cannot help you, I strongly advise you to consult with another attorney experienced in this area.