Legal Question in Personal Injury in North Carolina

Health Insurance Subrogation

I have Blue Cross Health/Blue Shield Health Insurance (Federal) and was injured in an auto accident. The guilty party's auto insurance liability limits equals only 1.5 times my billed medical expenses. My injuries were quite severe and should be approx. 5 times my medical expenses. Given the small settlement amount in relation to my injuries, am I required to reimburse Blue Cross/Blue Shield the full amount that they have paid for my medical treatment.

Asked on 1/23/04, 9:07 am

1 Answer from Attorneys

William Horsley William F. Horsley, P.A.

Re: Health Insurance Subrogation

This is not a "true" subrogation, but is instead a contractual right of reimbursement. While North Carolina insurance regulations prohibit this practice, if the insurance coverage in question is provided as an employee benefit the state regulation is superseded by Federal law (ERISA). Generally, a compromise can be reached at the time a settlement is agreed upon, though sometimes the carrier is difficult. Did you have underinsured motorist coverage? If so, and if your UIM coverage exceeds the liability coverage of the tortfeasor, you should make a claim. It will not cause an increase in your rates, nor can your carrier cancel your auto policy if you make a claim.

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Answered on 1/23/04, 11:15 am

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