Health Insurance Subrogation - What Is It?

To subrogate means to "put into the place of others." In terms of civil law, subrogation means to substitute one person (or entity) in exchange for another in terms of legal claims. Medical insurance subrogation means that if your insurance company pays a claim on your behalf, they then have the right to act on your behalf and sue the party responsible for the claim. For example, if you are hurt on the job and your standard health insurance policy pays for the Emergency Room visit required, the insurance company can then file suit against any worker's compensation insurance your employer maintains, with or without your permission.

Likewise, health insurance subrogation is often used in instances of automotive accidents and their resulting medical claims. To better illustrate, consider this scenario: you are in an accident that totals your car and sends you to the hospital with a broken collar bone. You may have initially given your standard medical insurance information when you received medical care. Your automotive policy covers the repairs to your car. Later, police officials determine the other driver was at fault for the accident. That would make their insurance provider liable for damages and medical costs. However, since these were already paid by your health plan and automotive insurance providers, there are no outstanding bills.
In such cases, subrogation is used to allow your insurance providers to file suit against the at-fault driver to re-coop their expenses. In some cases, your insurance company may file suit against the other driver, his insurance company, or even against other insurance policy providers you have, depending on the situation and laws of your state. Health insurance subrogation works similarly to automotive insurance subrogation. The primary difference being that claims are entirely medical, rather than covering damages or loss of property. Not all companies actively seek subrogation for all claims.

In similar scenarios where your medical insurance and automotive insurance companies pay claims that are deemed the responsibility of a third party or their insurance, subrogation can become a confusing mess. Your health plan provider may initially pursue health insurance subrogation against your automotive insurance provider. Your automotive insurance provider may argue that the at-fault driver's insurance should pay, as well as reimbursing their expenses for vehicle damages. This can create a tangled mess of civil suits and bickering insurance providers. Such cases often require the intervention of the legal community in order to resolve who should be reimbursing whom. If you need assistance in locating particular coverages at a pre-determined price, we can help save 50% on health insurance.