The Importance of Insurance Coverage: An Overview

When it comes to personal injury, the question of insurance coverage is almost inextricably woven into the fabric of any potential injury claim. In today’s society, where people are less risk averse and, it seems, technological advances pose either a latent hazard or driving distraction, insurance (in its various forms) is undoubtedly a necessity. While a hassle to purchase and expensive to maintain, the concept of insurance coverage seems simple enough on its face. Its interaction with a claim for personal injury, however, is typically more complex.

From a plaintiff’s health insurance coverage and the possibility of the aforementioned insurer’s subrogation rights, to commercial coverage, automobile insurance, home insurance and of course, the added annoyance of negotiation and settlement – insurance plays an integral, and multifaceted, part in personal injury cases. In fact, its very nature, coupled with adjusters’ penchant for lowballing claimants, makes it inarguably advantageous for claimants to consult a personal injury attorney from the outset – even during a claim’s earliest stages.

No matter the cause of injury, whether it be an auto accident, premises liability issue, design defect or intentional tort, when a person is injured, his or her primary concern should be reaching maximum medical improvement. It is here that health insurance comes into play. Many victims don’t seek immediate medical attention either because they don’t have medical insurance or because they wish to first explore their legal options. They fail to realize the toll inaction takes not only to their claim, but also on their health. In truth, it may take months, or even years for a case to resolve and, in the meantime, an unexplained gap in treatment serves as a red flag for adjusters, while simultaneously extending a patient’s recovery time. In this regard, it’s important that consumers be proactive about obtaining insurance and seeking medical assistance should the need for it arise.

After an accident victim has sought medical treatment for his or her injuries, it is entirely rational for their thoughts to turn towards compensation. Damages, as they are so aptly dubbed, compensate the injured for a plethora of both tangible and intangible expenses, including medical bills, lost wages, pain and suffering or even loss of consortium for a family member. Where there are particularly egregious factors, such as malicious behavior or allegations of drunken driving on behalf of the defendant, punitive damages might also be recouped.

In this vein, it should be noted that the very possibility of compensation emphasizes the need for plaintiffs to seek medical attention. Having a solid diagnoses in hand, as well as a plan for treatment, enables an insurance adjuster to more properly set their reserves at the outset of a case– with their reserves being the amount of money they will ultimately pay in order to resolve a claim.

Even when an injury occurs, recovery itself is not always cut and dry. There are a myriad of legitimate defenses available to the insured. Defenses applicable to a plaintiff’s particular case may often depend upon many factors, including circumstances, available coverage and the degree to which a plaintiff may have contributed to his or her own injury.

Subrogation refers to a third party’s right to recover monies paid to or on behalf of an injured person. With personal injury cases, the third party is typically a health insurance, disability or automobile insurance carrier. Based upon equitable principles and considerations, subrogation, which is intended to prevent a personal injury plaintiff from recovering twice for a single injury, essentially allows an insurer to step into a plaintiff’s shoes come settlement time.

While considering the potential for settlement, personal injury plaintiffs should bear in mind that, in some instances, the insurer disbursing payment for their health services may be entitled to reimbursement. There is no guarantee, however, that the insurance company will actually be permitted to recover.

Using various legal doctrines, skilled personal injury attorneys are often able to either negotiate a reduced repayment amount, or dispense with an insurer’s subrogation rights in their entirety if it can be proven that the plaintiff was not “made whole” again after settlement. This may be admittedly more difficult where a plaintiff’s health insurance was acquired through a group plan. In such cases, claims for subrogation or reimbursement may be governed by the often less lenient federal law.

Of course, every situation is unique, and it is best that an injured person consult with their lawyer in order to identify the options actually available to them should they be served with a subrogation notice.

The above are just some of the roles insurance plays in claims for personal injury, and may not be applicable to every situation. Consulting or retaining an attorney will allow for an individual assessment of your case. Representatives at Attorney Client Match are prepared to match you with an attorney best suited to your particular needs. Contact us today for a free consultation.