Getting The Health Insurance Benefits You Deserve – Virginia’s
Anti-Subrogation Statute
by
Jonathan T. Wren, Esq.
Martin & Raynor, P.C.
1228 Cedars Court
Charlottesville, Virginia 22903-4801
Telephone: (434) 817-3100
Fax: (434) 817-3110
Thanks to the wisdom of the Virginia General Assembly, people who live or work in this state and are injured on account of someone else, and through no fault of their own, are entitled to the full benefit of their health insurance even though the wrongdoer’s liability insurance provides coverage for the injury. Code of Virginia § 38.2-3405.
Typically, when a person is injured and seeks medical attention, that person gives the medical provider his/her health insurance information. The medical provider then provides the necessary services and sends the bill to the injured person’s health insurer.
In some cases, the health insurer then sends a letter to the medical provider and/or the injured person disclosing that certain limitations may apply to reduce or eliminate the injured person’s health insurance benefits. Specifically, this firm has received letters from health insurance companies claiming that our client’s health insurance “does not duplicate benefits that would be paid or payable by any other valid and collectible insurance, including automobile insurance,” or more simply that our client’s health insurance “does not cover … claims covered by other insurance.”
In other words, in these cases, the health insurance company is relying on certain language in its contract or plan with its insured to deny coverage, or demand repayment of benefits paid, if there is “other insurance.” This concept is known as subrogation or coordination of benefits and it effectively operates to reduce or eliminate compensation to injured persons.
But subrogation and coordination of benefits is illegal in Virginia where it would “operate to reduce benefits [to the injured person] because of any benefits paid, payable, or provided by any liability insurance contract … or by any medical expense or medical payments insurance provided in conjunction with liability coverage.” Code of Virginia § 38.2-3405(B).
In plain English, what this means is that a person living or working in Virginia who suffers personal injuries on account of someone else’s conduct is entitled to the benefit of his/her own health insurance without regard to whether or not the injured person might also receive compensation from a liability insurance policy covering the same injuries. Essentially, the injured person is entitled to the benefit of his/her bargain with his/her health insurance company, while at the same time receiving compensation under the law from the wrongdoer’s liability insurance company.
This policy does not exist in all states and helps to make it more likely that Virginians are fully and fairly compensated for personal injuries that they suffer on account of someone else and through no fault of their own.
If you live or work in Virginia and receive a letter from a health insurance company demanding subrogation and/or coordination of benefits with regard to medical bills incurred as a result of an accident that you did not cause, stand up for your rights. And if your health insurance company does not do the right thing, consult an attorney.