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  1. #1
    Join Date
    Apr 2006
    Posts
    147

    Default Insurance Company Wants Repayment Of Medical Care Benefits

    I am in california.

    More than 3 years ago April 1997. I was in a car accident I was injured. My gril friend at the time handle my accident claim (she is my x-girlfriend now). She was in law school at the time.

    Now I got a call from my insurance company they said I owe them $1800 for the amount they paid for my injury 3 years ago. I don't remember any of the detail from 3 years ago. My X handled everything. She never because a lawyer.

    So I called her at frist she said I have nothing to worry about because I never signed anything and I have never heard from them since this date, and I have not. And it is not the $1800 anyways. It is usually $1800 - 1/3. I have some concerns of course and had questions. At the end she said I was on my own. Akward to get legal advice from an x.

    Then today. I got a call again from my insurance company. I said I don't remember things that happen 3 years ago and I was not the person handeling the case. I said can we work out something less than $1800. They said no and unless I paid the full $1800 it is going to collection. They were firm.

    So my questions are. 1) If it has been 3 years ago has it been too long for them to collect, statue of limitation. 2) If it has not been to long do I owe them $1800 or $1800-1/3.

    Pleased don't judge for trying to reduce the amount I may owe. I did a little research it is uaually $1800-1/3 pay back to your insurance company.

  2. #2
    Join Date
    Mar 2005
    Location
    Michigan
    Posts
    28,906

    Default Re: help my insurance is comming after me.

    Your insurance wants money from you for what reason?

    Yes, 1997 is more than three years ago. Did you type the date correctly?

  3. #3
    Join Date
    Apr 2006
    Posts
    147

    Default Re: help my insurance is comming after me.

    Quote Quoting aaron
    View Post
    Your insurance wants money from you for what reason?

    Yes, 1997 is more than three years ago. Did you type the date correctly?

    They said. They paid for my medical bills and then later I got a settlement from the other insurance company.

    So sorry about th date. It was April 2004, so over three years ago. But I am upset about the situation.

  4. #4
    Join Date
    Apr 2007
    Location
    Il.(near StL,Mo.)
    Posts
    5,252

    Default Re: help my insurance is comming after me.

    Did you get a settlement from the other ins. co. for your medical bills? If so, you needed to pay back your ins. co. out of the settlement what they paid for your medical bills. Otherwise, it's like you are being paid twice.

  5. #5
    Join Date
    Apr 2006
    Posts
    147

    Default Re: help my insurance is comming after me.

    Quote Quoting Betty3
    View Post
    Did you get a settlement from the other ins. co. for your medical bills? If so, you needed to pay back your ins. co. out of the settlement what they paid for your medical bills. Otherwise, it's like you are being paid twice.
    Yes I got a settlement but it was for a lump sum but including wage loses damages to my car I don't hink I got the full medical bill.

    According to what I found out. My understanding is that I may have to pay a portion of it, if statue of limitation has not expire. First, has it? My understanding is it that I only have to pay 2/3 of the medical bill.

    I think my insrance company is just playing hard ball. I have said I was willing to negotiate the amount. But they will not have anything to do what that. Like I said they are just palying hard ball. My insrance company told me that if I don't pay the full amount in 15 days. It is going to collection.

    My feeling is if paying 2/3 is standard why should I pay 100% after 3 years after no fault of my own.

  6. #6
    Join Date
    Sep 2005
    Location
    Behind a Desk
    Posts
    98,846

    Default Re: help my insurance is comming after me.

    You believe you should only have to pay them 2/3 of the money, for what reason?

    If you wish to try to negotiate a lower payoff, try to do exactly that.

  7. #7
    Join Date
    Apr 2006
    Posts
    147

    Default Re: help my insurance is comming after me.

    Quote Quoting Mr. Knowitall
    View Post
    You believe you should only have to pay them 2/3 of the money, for what reason?

    If you wish to try to negotiate a lower payoff, try to do exactly that.

    My understanding under california and fed common law subrogation. Since my insurance company have none of the work recovering my med losses and we(my x-girlfriend) have done all of the work they should not be able to recover the full amount. In fact we can make a case they have harm my case.

    Also, I did a little more research. California Civil Code 3040. It look like if I have an attorney they have to take a 1/3 reduction and if I don't have an attoney they have to take a 1/2 reduction. I think this applys to my situation what do you guys think?


    3040. (a) No lien asserted by a licensee of the Department of
    Managed Care or the Department of Insurance, and no lien of a medical
    group or an independent practice association, to the extent that it
    asserts or enforces a lien, for the recovery of money paid or payable
    to or on behalf of an enrollee or insured for health care services
    provided under a health care service plan contract or a disability
    insurance policy, when the right of the licensee, medical group, or
    independent practice association to assert that lien is granted in a
    plan contract subject to the Knox-Keene Health Care Service Plan Act
    of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of
    the Health and Safety Code) or a disability insurance policy subject
    to the Insurance Code, may exceed the sum of the reasonable costs
    actually paid by the licensee, medical group, or independent practice
    association to perfect the lien and one of the following:
    (1) For health care services not provided on a capitated basis,
    the amount actually paid by the licensee, medical group, or
    independent practice association pursuant to that contract or policy
    to any treating medical provider.
    (2) For health care services provided on a capitated basis, the
    amount equal to 80 percent of the usual and customary charge for the
    same services by medical providers that provide health care services
    on a noncapitated basis in the geographic region in which the
    services were rendered.
    (b) If an enrollee or insured received health care services on a
    capitated basis and on a noncapitated basis, and the licensee,
    medical group, or independent practice association that provided the
    health care services on the capitated basis paid for the health care
    services the enrollee received on the noncapitated basis, then a lien
    that is subject to subdivision (a) may not exceed the sum of the
    reasonable costs actually paid to perfect the lien, and the amounts
    determined pursuant to both paragraphs (1) and (2) of subdivision
    (a).
    (c) If the enrollee or insured engaged an attorney, then the lien
    subject to subdivision (a) may not exceed the lesser of the following
    amounts:
    (1) The maximum amount determined pursuant to subdivision (a) or
    (b), whichever is applicable.
    (2) One-third of the moneys due to the enrollee or insured under
    any final judgment, compromise, or settlement agreement.
    (d) If the enrollee or insured did not engage an attorney, then
    the lien subject to subdivision (a) may not exceed the lesser of the
    following amounts:
    (1) The maximum amount determined pursuant to subdivision (a) or
    (b), whichever is applicable.
    (2) One-half of the moneys due to the enrollee or insured under
    any final judgment, compromise, or settlement agreement.
    (e) Where a final judgment includes a special finding by a judge,
    jury, or arbitrator, that the enrollee or insured was partially at
    fault, the lien subject to subdivision (a) or (b) shall be reduced by
    the same comparative fault percentage by which the enrollee or
    insured's recovery was reduced.
    (f) A lien subject to subdivision (a) or (b) is subject to pro
    rata reduction, commensurate with the enrollee's or insured's
    reasonable attorney's fees and costs, in accordance with the common
    fund doctrine.
    (g) This section is not applicable to any of the following:
    (1) A lien made against a workers' compensation claim.
    (2) A lien for Medi-Cal benefits pursuant to Article 3.5
    (commencing with Section 14124.70) of Chapter 7 of Part 3 of Division
    9 of the Welfare and Institutions Code.
    (3) A lien for hospital services pursuant to Chapter 4 (commencing
    with Section 3045.1).
    (h) This section does not create any lien right that does not
    exist at law, and does not make a lien that arises out of an employee
    benefit plan or fund enforceable if preempted by federal law.
    (i) The provisions of this section may not be admitted into
    evidence nor given in any instruction in any civil action or
    proceeding between an enrollee or insured and a third party.

  8. #8
    Join Date
    Mar 2005
    Location
    Michigan
    Posts
    28,906

    Default Re: help my insurance is comming after me.

    It isn't clear from what you have posted that the statute even applies to your situation. What insurance company is seeking reimbursement?

    Also, the limit relates to a percentage of your total recovery, not the total medical bill. It remains possible to collect the entire medical bill.
    (d) If the enrollee or insured did not engage an attorney, then the lien subject to subdivision (a) may not exceed the lesser of the following amounts:
    (1) The maximum amount determined pursuant to subdivision (a) or (b), whichever is applicable.

    (2) One-half of the moneys due to the enrollee or insured under any final judgment, compromise, or settlement agreement.
    If you settle a claim for $10,000.00, subsection (d)(2) limits the lien to $5,000.00. What was the settlement amount with the other insurer?

  9. #9
    Join Date
    Apr 2006
    Posts
    147

    Default Re: help my insurance is comming after me.

    Quote Quoting aaron
    View Post
    It isn't clear from what you have posted that the statute even applies to your situation. What insurance company is seeking reimbursement?

    Also, the limit relates to a percentage of your total recovery, not the total medical bill. It remains possible to collect the entire medical bill.

    If you settle a claim for $10,000.00, subsection (d)(2) limits the lien to $5,000.00. What was the settlement amount with the other insurer?
    It was for more than $5,000. But I had lost wages which exceed 4k and pain and suffering. So this statute will not help me.

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