Subrogation is a difficult concept for most people to understand. Essentially, it allows for the health insurance company to recoup funds they have paid when the person is injured by a third party. In my office, we work diligently for our clients on this issue. I think my clients are always surprised to hear that their health insurance company is going to be able to take a portion of their recovery. They often feel it is unfair since had they not brought the claim then the insurance company would not have recovered anything. We have found that most of the health insurance companies are willing to work with us on these claims. Medicare and Medicaid who are also entitled to be reimbursed for bills they have paid on a claim are more difficult to deal with.
Judy Kostura is probably the most knowledgeable attorney in Texas on the issue of subrogation. She explains the issue in the following article:
http://www.statesman.com/opinion/content/editorial/stories/04/16/0417kostura_edit.html
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Subrogation of workers comp or healthcare payments are troubling for many PI attorneys and injured parties. There are some very strong social and business reasons for subrogation though that often get lost in the passion when a party is not "made whole." These include:1. The reduction of insurance costs for society;2. Vigilance against wrongdoers - that may not happen at times if the subrogation professionals were not championing the recovery efforts; and3. The identification of defective products and practices due to pooling of insurance subrogation resources (State Farm's subro group identified the Goodyear tire/Ford Explorer problem first).There are extreme cases that can be used to highlight subrogation injustice, but for the most part it is a very positive aspect of the insurance industry and very gainful to society.
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