U.S. Supreme Court Decision Affects Personal Injury Victims
April 18, 2013
You’ve suffered a personal injury due to someone else’s carelessness.
You have extensive injuries that require surgery and leave you with permanent
pain. As is required by your contract (and more importantly, because you
paid your premiums) your health insurance company has paid for your medical
treatment. You hire a personal injury lawyer to help you obtain the maximum
amount of compensation possible. Even though your claim is worth hundreds
of thousands of dollars, you learn that there is only $100,000.00 worth
of insurance coverage for your injuries.
During the time you are recovering you learn that your health insurance
company claims that if you get money from a settlement, the health insurance
company gets paid back before you can get any money. The health insurance
company tells you that they are owed over $60,000.00!!!!! You ultimately
settle your case for the $100,000.00 (because that is all the money that
is available) and after attorneys’ fees, you learn that not only will
you not get ANY MONEY, you actually owe the health insurance company money.
Your attorney says, “Hey this is not fair, the person who got injured
does not get any money for their injuries? Surely this cannot be true.”
So your attorney tries to negotiate a deal with the health insurer but
they won’t budge. They want all your money. Your attorney says, “Hey
my client had to hire me to get this case resolved and without my effort
you would not have received anything. Why don’t you guys just reduce
your claim by the same percentage of my attorney’s fees so that my
client can receive some money for all that she has been through?”
Again, the health insurer says no, we have a contract that allows us to
get everything and we want it all. Thus, sets the stage for a case that
was recently decided by the U.S. Supreme Court.
This is the underlying facts of the case of
U.S. Airways v. McCutchen that was recently decided by the U.S. Supreme Court. In this case, the
attorney for the injured party argued that it was simply unfair for the
health insurance company to take all of the money from the injured party.
The Supreme Court said that under the federal rules, the health insurance
contract controls and if the health insurer wants to take all the money
and their contract allows for it, then there is nothing that can be done.
In this particular case, the Supreme Court took a very strained reading
of the contract to allow for the injured party to get some money, but
effectively gave the health insurers a road map to ensure that they get
ALL OF THE MONEY, LEAVING THE INJURED PARTY WITH NOTHING. As lawyers,
we certainly respect the ruling of the Court, but this result is simply
unfair! Our hope at Henningsen Injury Attorneys is that we can band together
with other trial lawyers to petition the government to change this law.
WHY THIS IS UNFAIR
- When you have health insurance you pay a premium for this health insurance. This premium is not reduced by the amount of money that the insurance
company thinks that they are going to be paid back from injury claims.
This premium is calculated based on actuarial tables that DO NOT take
this into account. Why is this important? It means that this money is
simply going to line the pockets of the insurance companies and not being
passed on as savings to the insureds.
- What happens to the injured party in this case? If they do not receive any funds and are disabled the insurance company will want them to go
on to Medicare or Medicaid. This means that the health insurer collected
their premiums, got all of their money back, and now has forced injured
party on to the federal and state government for assistance…. and ultimately
on to the tax payers to pay for these injuries.
- This goes against our basic understanding of fairness and justice. The person who was impacted the most by the carelessness of someone else gets
nothing (and in fact in this case owes the health insurer).
- There are (and will be) cases where a health insurer’s lien is so large that it simply does not make sense for the injured party to ever pursue
a claim against the responsible party. In Georgia, because a personal
injury claim is not assignable, this will mean that the health insurer
gets nothing, the injured party gets nothing, and the person who caused
the injuries gets off without having to face any responsibility!
We hope that citizens across America will understand that this is simply
unfair. Insurance companies are profiting off of others misfortune while
the real parties that are hurt are simply left to cope on their own.