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Ask an Attorney a Question for FREE!

Is my Settlement for the Full Doctor's Fee or the Discounted Insurance Rate?

by Anonymous
(California)

I was in a car accident. I'm starting to receive medical bills from the Hospital Facilities. I also have very good Medical insurance that has been taking care of my expenses.

However, since all the doctors that treated me are within my insurance network I get a discount applied to the total balance which is a great savings for me.

My question is, when I start adding my total for my settlement demand, should I include the initial doctor's visit fee or the discounted balance?

How does that work when it comes to the other insurance at fault. Will they pay the full balance or the discount total?

Disclaimer: Information provided in your response is not formal legal advice, it is generic legal information and is based on the very limited information given in your question. You should always get a formal case evaluation from a licensed attorney.

Comments for
Is my Settlement for the Full Doctor's Fee or the Discounted Insurance Rate?

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Collateral Source Rule
by: Law Lady

You are in the same situation as many personal injury claimants who have excellent coverage. However the liable party does not get to benefit from your quality medical plan by only considering what you paid rather than the value of these services to you.

This is a classic collateral source question, meaning that the defendant does not get to benefit from the contributions of a collateral source (i.e. your insurance).

Look at the total value of these services, not the reduced percentage that was actually paid when you are putting together your demand.

Now, your insurance may seek reimbursement or indemnification for the monies that they paid out if you receive a personal injury settlement. The law considers this fair and in reality, it is. Your insurance covered hundreds maybe even thousands of dollars in benefits received by you.

You will then re-coupe those expenses in the form of a settlement. It is only right to pay your insurance back. What's nice, however is that if they do have an indemnification provision (and some do not so check it out), they will reduce these expenses by up to 50%, depending on what you can negotiate with them.

Since laws change frequently and across jurisdictions you should get a personalized case evaluation from an attorney licensed in your state (if you haven't already). Find an experienced local attorney to give you a FREE personalized case review here.

Best of luck,

Law Guy
re: Insurance wanting their money back
by: Anonymous

Can I ask my lawyer to find out from my Insurance if they have indemnification negotiations and negotiate for me before we put demand?

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