What Is Subrogation?

The weeks and months after a serious accident or personal injury may be filled with unfamiliar terms and processes, adding to the stress and emotional toll of the injury. Sometimes “subrogation” is one of the terms bandied about in the process of an injury claim. So, what is subrogation and how does it impact your compensation claim after an accident or personal injury?

Subrogation in Personal Injury Claims

In layman’s terms, “subrogation” usually applies to an insurance company’s attempt to seek reimbursement for what they’ve paid for an injury victim’s medical care. For instance, if you were seriously injured in a slip-and-fall accident in St. Louis and received emergency medical treatment and later surgery for a back injury, your medical insurance may have immediately paid for the treatment in fulfillment of the terms of your contract. However, when the slip-and-fall injury occurred because of a store owner’s negligence and you file a claim for your damages, your medical insurance provider may use the subrogation process against the same at-fault party to recover what they’ve paid for your medical costs. Car insurance companies may also seek subrogation for their costs if they paid for some or all of your medical costs under your personal injury protection (PIP) policy.

Subrogation is common in many states, but Missouri prohibits this practice in the majority of cases, protecting injury victims from having to use their compensation to reimburse their insurance carriers.

What Are Missouri Laws on Subrogation?

Missouri has unique anti-subrogation laws so an injury victim is not responsible for reimbursing their health or auto insurance company for the amount they’ve paid out for medical expenses. Unfortunately, exceptions to Missouri’s anti-subrogation laws apply in some cases. For instance, workers’ compensation and employer-sponsored health insurance fall under federal law rather than state law under the Employee Retirement Income Security Act (ERISA). Under this federal law, employer-sponsored health insurance providers may file for reimbursement for what they’ve paid in an injury victim’s case. If they aren’t reimbursed, they may refuse further payment for any future medical care.

Federal healthcare plans like Medicare, Medicaid, and Tricare are also exceptions to Missouri’s laws against subrogation.

What Happens If I Receive a Subrogation Notice?

Anytime you receive a notice of subrogation, or if you’ve filed a personal injury claim after your federal medical insurance or employer-sponsored health insurance paid for your medical care, it’s important to seek representation through an experienced St. Louis injury attorney. An attorney can help minimize the amount of your settlement that goes to reimburse your federal insurance like Medicare, Medicaid, Tricare, or your workers’ compensation settlement.

In some cases, medical providers may resist submitting an injury victim’s claim to their medical insurance when they know the patient has a personal injury claim in process. They sometimes seek a medical lien to attach to the victim’s settlement because they can receive more money for the same medical care. However, rulings in the Missouri court compel medical providers to submit claims to a victim’s health insurance if they are aware that an insurance policy exists rather than placing a lien on their settlement. To do so means they waive their right to recover payment.

Handling Subrogation

If you receive a subrogation notice or your medical insurance company begins asking questions about the circumstances of your injury, you may need the guidance of an attorney familiar with navigating the complex state and federal laws to protect your best interests.