My Blue Cross-Blue Shield employer group coverage is wanting me to reimburse them for monies I received from my No Fault Personal Injury Protection coverage I pay for on my own personal Texas auto policy. The accident involved me alighting from my vehicle in December, 2010 and my left foot hit a patch of ice and I fell from my Suburban, fracturing my left ankle in two places. Blue Cross Paid my covered charges less some copays and annual deductible. I contact my auto insurance carrier and submitted a claim under my PIP coverage for copays, cost of boot not paid for by Blue Cross, lost wages (two weeks). I submitted EOB's from Blue Cross and my company reimbursed me the full amount of the medical bills I submitted. My employer waived my requirement to use my sick leave and so I lost no wages or sick days. I informed my auto carrier I was withdrawing my claim for lost wages. In my Benefits booklet I received in 2002, the subrogation portion and it reads "Coordination of Benefits-Definitions 1. Plan means any group insurance or group-type coverage, whether insured or uninsured. This includes ... "governmental plans, or coverage required or provided by law". Plan does not include: "any coverage held by the Participant for hospitalization and/or medical-surgical expenses which is written AS A PART OF OR IN CONJUNCTION WITH ANY AUTOMOBILE CASUALTY INSURANCE POLICY; a policy of health insurance that is individually underwritten and individually issued; school accident type coverage;

The subrogation clause is the normal wording. When I asked the BCBS representative do they recover from policies like AFLAC he informed me they do not. I explained to him that there was no third party involved in my accident, that alighting from a vehicle is covered under PIP which I pay the premium for-it is a no fault type coverage. I read him the above wording that it was my personal auto policy that I paid a premium for this optional coverage that I felt they did not have a right to subrogation in this case. The representative said that by stating in the subrogation clause states "means the Plan may use your rights to recover money through Judgment, settlement, or otherwise from ANY PERSON, ORGANIZATION, OR INSURER. that they have the right to recover from my PIP carrier or I need to reimburse them what they paid out.

Thank you,

Sandy Bond

Shamrock, TX

wjp2@centramedia.net or

az47@sbcglobal.net