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  1. #1
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    Mar 2018
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    Default Is There a Time Limit for Subrogation Against an Injury Claim

    My question involves an injury that occurred in the state of: Louisiana. I was involved in a not at fault vehicle accident and I sustained herniated discs, back injuries. I used my private Healthcare (It is not through an employer) for treatments after the accident which included physical therapy, nerve blocks, radiofrequency ablations, Orthopedic consultation. The treatment was within the first year. Finally after about two years from the accident my attorney has negotiated a settlement amount for the personal injury. I have not received any subrogation letters. How long does Healthcare Insurance have to assert subrogation? One year? Two years? Or much more?

  2. #2
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    Mar 2013
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    Default Re: Subrogation Time Limit

    It would be a contractual issue and I think the statute of limitations is 10 years.

    But you don't want to wait.

    Your lawyer is responsible for taking care of the subrogation lien on your settlement before you get your share.

    Ask him about it.

  3. #3
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    Default Re: Is There a Time Limit for Subrogation Against an Injury Claim

    Quote Quoting Dawn2
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    Finally after about two years from the accident my attorney has negotiated a settlement amount for the personal injury. I have not received any subrogation letters.
    Have you discussed any liens or subrogation issues with your lawyer? Is this issue purely theoretical?

    Your obligation to report the recovery to your insurance, and when that obligation is triggered, is a matter of contract. You would need to read your insurance policy to determine if you were under an obligation to inform them of a potential tort recovery for an injury for which they provided coverage for your medical care.

    But even if they have a lien, your lawyer may be considering the possibility of a lien and how to avoid any assertion of rights by your private health insurance through the manner in which the settlement is structured.

  4. #4
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    Mar 2018
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    Default Re: Subrogation Time Limit

    Thank you. I will try to obtain copy of insurance contract. Attorney said he is obligated to take care of any liens, but since there are no liens he recommended just setting settlement aside for awhile in case I receive subrogation lien later. I am unsure if he is simply trying to save himself extra work or if this is common practice. My state is a "made whole" state. Do health insurance companies tend to not purse liens in "made whole" states? I'm concerned insurance is purposely waiting long after settlement, after I am no longer represented by an attorney, to pursue liens and then they will tack on fees and interest. Can insurance tack on extra fees and interest in future?

  5. #5
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    Mar 2013
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    Default Re: Subrogation Time Limit

    Do the SMART thing and call up your medical insurance company and ask if your plan has a right of reimbursement.

    If it does, insist on seeing the plan page in print.

    Then ask for a print out of what you would have to pay back if you have to pay anything back.

    Your state's "made whole" doctrine appears a bit unpredictable.

    Louisiana refers to the Made Whole Doctrine as the “Full Compensation Rule” and requires an insured to be fully compensated before an insurer/Plan may exercise its subrogation rights. Southern Farm Bureau Cas. Ins. Co. v. Sonnier, 406 So.2d 178 (La. 1981); Carter v. Bordelon, 370 So.2d 113 (La. App. 1979). Unlike a majority of states, Louisiana does place the burden of proving full compensation on the insured/Plan beneficiary, as opposed to requiring the Plan/insurer to prove it. Wallace v. Aetna Life & Cas. Ins. Co., 499 So.2d 577 (La. App. 1986).
    The Louisiana Court of Appeals has indicated that the Made Whole Doctrine is considered a rule of interpretation or gap filler which becomes significant only when a contract or Plan fails to clearly address the issue. Nat’l Emp. Benefit Trust of the Associated Gen. Contractors of Am. v. Sullivan, 940 F. Supp. 956 (W.D. La. 1996); Roberts v. Richard, 743 So.2d 731 (La. App. 1999). The Louisiana Supreme Court has held that despite a subrogation clause, if the insured is less than fully compensated by tort recovery, the insurer is only partially subrogated, and the insured has complete priority in receiving payment. Sonnier, supra; Brister v. Blue Cross and Blue Shield of Fla., Inc., 562 So.2d 1040,1044 (La. Ct. App. 1990) (“What the Supreme Court held in Sonnier was that since the survivors had not been fully compensated, the subrogated insurer could not collect from the survivors the amount the insurer had paid them.”). However, in American Postal Workers Union v. Tippitt, 82 So.3d 379 (La. App. 2011), the Court of Appeals ruled that when a beneficiary/insured settles a case with knowledge of his obligation to reimburse the Plan, he cannot claim he wasn’t made whole.
    So make sure you know what your pay back potential is BEFORE agreeing to a settlement.

    If you don't, you could get hit with a big bill at some future date.

    Self preservation is nobody's business but your own, so don't ignore it.

  6. #6
    Join Date
    Mar 2018
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    3

    Default Re: Subrogation Time Limit

    Thank you for the information and advice!

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