The short answer is that the Health Insurance gets paid back the money it paid to your doctors and hospitals. You also get back whatever you paid out of pocket – your coinsurance, and your deductibles, and what you paid for prescriptions.
If you go to trial, you can ask the jury to give you more for the medical bills, but it’s probably a mistake.
But the jury will also make a separate award to you for your pain, your suffering and your lost wages. All these things – your medical expenses, your lost wages, and your pain and suffering – make up the damages you are entitled to recover.
When your health insurance company pays your medical bill, its payment gives it the right to be reimbursed by the person who caused the accident (let’s call him John) – or by you, if you recover from John. The law is not really clear on this, other than to say John does not have to pay both you and your health insurance company.
If your health insurance company paid $7,000 toward your medical bills, you or it can get that money back from John. And if you get the $7,000 back from John, you are supposed to pay it to the insurance company.
The jury knows that your health insurance company has paid your bills. So when I ask the jury to give you money, it’s always a good idea to ask them to give you the money so you can pay the insurance company back, like you have to.
Why is this a big deal? Because juries these days are very suspicious, and don’t want to give anyone, including you, a free lunch. But it does not end here.
If the health insurance company paid $7,000 to your doctors and hospitals, they probably submitted more than $10,000.00 in bills.
Why did the insurance company pay less than the actual bills? Because it gets a discount – the insurance company hardly ever pays full price for anything. Now, when we ask the jury for money, do we ask for $7,000 (what the health insurer paid) or $10,000 (what the doctors and hospitals billed)?
In Ohio, the jury can award any number between $7,000 and $10,000.00. But it will hardly ever award the higher number.
So here is what you should expect to get from the jury if you go to trial:
• The amount your doctors and hospitals accepted from your health insurance company. You will give this amount to your health insurance company.
• Whatever the jury decides to award you for your lost wages.
• Whatever the jury decides to award you for your pain and suffering.
I have been a lawyer over 30 years. I pay as much attention as I possibly can to where my client’s money is going. If you want to talk about what you can do to settle your case, speak with an experienced Cincinnati Injury Lawyer – call me, William Strubbe, at 513-621-4775 in Cincinnati.