A recent United States Supreme Court decision provides relief for persons injured in an accident, such as automobile, motorcycle, slip and fall, dog bite, etc. Many injury victims have their medical care paid by employer provided health insurance. When the injured person receives a settlement or verdict, they will likely need to reimburse their health insurance carrier for the amounts paid, less a credit for the attorney’s fees and costs the injured person had to incur in obtaining the settlement or judgment. While state law mandates that health insurance carriers reduce their rights to reimbursement to account for the attorney’s fees and costs, state law is inapplicable to most employer-based health insurance plans which are formed under federal law, known as ERISA. As a result, most employer-based health insurance carriers refuse to reduce the amount of their purported recoveries, even though the injured person expended significant effort, cost and money in collecting settlement proceeds.
In a recent decision from the United States Supreme Court, the court found that the health insurance carrier’s refusal to reduce the amount it is owed was unjust. Accordingly, the Supreme Court ordered that when the health insurance plan does not address the issue of collection of attorney’s fees, then the health insurance carrier must decrease the amount it is owed by a proportion of the attorney’s fees and costs paid by the injured person in collecting the settlement. In essence, the Supreme Court decision represents the principle that it was unfair for the insurance companies to benefit from the harvest, without sharing in the labor.
If you have any questions regarding your personal injury claim and/or the reimbursement of insurance, please contact Hamblett & Kerrigan for a consultation.
Kevin P. Rauseo is a former director at Hamblett & Kerrigan P.A. and has since been appointed as a Justice for the New Hampshire Circuit Court. Please feel free to contact another attorney at Hamblett & Kerrigan to discuss your legal issues.