Legal Question in Insurance Law in Pennsylvania

Insurance reimbursement

My husband's health plan took the money I received in a auto accident settlement that was to be used for my dental implants. They won't cover the procedure either and my dental injuries are getting much worse as a result. I did not sign a subrogation agreement and did not know about this practice until 2 wks after I signed settlement.

I understand they can negate the ''made-whole rule'' (unbelievably, just by putting it in the contract), but what if they are causing further harm? Could I sue them for the money they took?

(This is an ERISA plan)


Asked on 8/02/06, 1:08 pm

1 Answer from Attorneys
Roger Traversa Arjont Group (Law Office of Roger Traversa)

Re: Insurance reimbursement

You asked if you had recourse where insurance subrogation intercepted an insurance settlement.

If you had an attorney in the insurance settlement then you should deal with him or her to resolve this issue. If you did not have an attorney now you know why you should have had one.

There are alternatives for you to try from appealling the matter through the proper channels at the insurer and employer. You could also try reopening the settlement but that is a long shot.

As a general rule an insurer is not necessarily responsible for deny coverage in non-life threatening situations. The alternative is that you cover the procedure yourself and seek reimbursement.

As often is the case, you need an attorney to go to bat for you.

Regards,

Roger Traversa

Email: [email protected]

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Answered on 8/02/06, 1:47 pm


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