Legal Question in Personal Injury in Pennsylvania
Good Evening - I was recently injured while on vacation in the condo I was staying in. I broke and sprained my ankle while evacuating the building at 11:00 pm due to a fire alarm. The condo's liability company has provided to me the opportunity for payments, to cover my out of pocket expense (up to $5,000) under a Medical Payment Provisions rider on their liability policy. Per their letter they write, "...while we are willing to reimburse you for your out of pocket expenses, it is not admission of liability and any payments made to you...are done so with the understanding that those payments will be included in any settlement we may reach."
I don't anticipate a settlement of any sort, because I believe this situation to be truly an accident, through no fault of the condo owner.
I received a letter from my medical insurer today stating that based on some "codes" coming through their system, they believe my injury and claims may be subject to subrogation.
I guess my questions are:
#1 If I accept money from the liability insurer for my out of pocket, based on their rider to the policy, is that money subject to the subrogation?
#2 If I don't plan any sort of legal action against the condo, and only want to collect the out of pocket, do I need to inform my medical carrier?
Their form mentions if �the injury was someone else�s fault, or just on someone else's property�; So do I just give them the information and let them do their own investigation?
I don't feel my insurance company should be entitled to any money on the liability policy because, again, it was purely an accident. If so, I don't even want to collect the out of pocket expenses if I have to just turn them over to the insurance company. I'm hoping because they admit no liability and are just providing the "up to $5,000" separately, it won't be subject to the subrogation.
Any guidance would be appreciated. Thank you very much.
2 Answers from Attorneys
You should be entitled to the med pay and it won't affect your recovery for pain and suffering. Give our offices a call to discuss. My direct line is 267.639.3105.
The med pay part of the condo ins policy typically obligates the ins co to pay med bills regardless of fault. You could be 100% at fault. The typical health ins policy (even group policies issued thru your employer) provide for subrogation or reimbursement to the health insurer if you receive money from another source. For example, if your health ins co paid med bills of $2500, & you paid $300 in deductibles, co-pays, etc, the condo ins co would pay you $2800, but you would be obligated to reimburse the health ins $2500. However, usually you can negotiate with the health insurer. Frequently they will take 50% or less if you negotiate correctly. In answer to your Q#1- don't do anything that would prejudice the health insurer's right of reimbursement- don't sign a release or other document to get money from the condo ins co unless you're getting enough to satisfy the health ins co. If you received a form from the health ins co, you are obligated to be honest. However, you may be better in contacting the health ins co by tel & trying to negotiate rather than completing the form. Good luck!
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