What is Health Insurance Subrogation?

Have you been involved in a car crash that wasn’t your fault? If you sustained injuries, it is likely that you were treated at an emergency room or medical facility. Did you notice that the doctors and/or insurance wanted the at-fault party’s information? Your health insurance company may have the right to recover some or all of the medical expenses they paid on your behalf. This process is known as subrogation.

Subrogation allows your health insurance company to recover the medical expenses they paid on your behalf from any settlement or judgment you receive from a third party, such as the at-fault driver or their insurance company. This is done to prevent the insured person from receiving a windfall and being paid twice for the same expenses – once by their health insurance company and again by the third party responsible for the accident.

The process of subrogation can be complicated and is often a source of confusion for those involved in car accident cases. If you have health insurance and are involved in a car accident, it is important to understand your insurance policy and the potential for subrogation.

While it may seem frustrating that your health insurance company wants a portion of your settlement, it is important to remember that the insurer may have a legal right to recover its payments from any settlement or judgment obtained by the insured person; the terms of subrogation are usually outlined in the health insurance policy contract which you signed.

Further, the policy language may require you to notify the insurance company of any potential settlement or judgment you receive from a third party. Failure to notify the insurance company may result in a breach of your insurance policy, which could lead to the insurance company denying further coverage.

It is important to note that the amount of subrogation can vary depending on the specific circumstances of your case. In some instances, the insured person may be able to negotiate with their health insurance company to reduce the amount of subrogation or reach a compromise especially when the settlement received is a lesser amount than what the health insurance company paid out in medical benefits. It is important to consult with a qualified attorney to determine the best course of action for your specific situation.

 Our law office is available and ready to help, contact Ray Padilla Law, APC today at (619) 431-1187 (San Diego) to speak with Attorney Ray Padilla directly.  Please call even if it’s simply to ask, “what should I do?”


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