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  • Writer's pictureClinton Morgan

What Is Subrogation?

Subrogation is a legal concept that allows one person or entity to substitute another, to assert a claim for what they're entitled from the party that's liable for damages. It's an integral part of most personal injury cases because health insurance companies, Medicare, Medicaid, hospitals, and other providers will assert their subrogation rights for the medical care they have paid for against the at-fault party. These claims can impact the amount of compensation you receive for pain, suffering, emotional distress and other claims, so it's important to work with a personal injury attorney in Texas that knows how to negotiate subrogation claims so that you can collect the highest possible amount of compensation.

Health Insurance and Subrogation in Texas

If your health insurance policy is covered by the Employee Retirement Income Security Act of 1974 (ERISA), negotiating with your health insurance company can be challenging negotiate with due to restrictions under Federal law. Texas policies that are not covered by ERISA are more advantageous to injury victims, limiting subrogation by insurers to the lesser of the following:

  • Half of the gross recovery after deducting attorney's fees and costs OR

  • The total cost of benefits paid, assumed, or provided, less attorney's fees and costs.

When insurance coverage is ample, insurers can collect the total amount that they've paid out. When policy limits are lower, the first prong protects the rights of injured people to collect compensation for pain, suffering, emotional distress, lost earnings, and other claims by limiting how much of the gross recovery can be paid out for subrogation.

Medicaid and Medicare Subrogation in Texas

When government entities have paid your medical bills, they are also entitled to subrogation, but can be more amenable to reducing their claims than private insurers. For example, Medicaid will usually significantly reduce what they are willing to accept after an experienced Texas personal injury attorney explains how the injured person needs the money. Medicare subrogation in Texas includes both PIP and medical benefits covered under the policy, so it's essential to consider this when negotiating the claim. Properly negotiating with Medicaid and Medicare is crucial to protect you from claims against you after your case is completed and ensure that your benefits remain in place.

Workers Compensation Subrogation in Texas

If you're injured on the job, your medical costs and lost earnings benefits are likely to be paid by your employer's worker compensation insurance policy. With some exceptions, workers covered by workers compensation in Texas are limited to collecting workers compensation benefits and cannot sue their employers for negligence, but workers can sue third parties that are liable for causing their injuries. For example, if a worker is injured by a delivery truck or by another driver on the road, a claim can be made against these third parties. In such cases, the workers compensation carrier has a right to subrogation against the third party to recover what they've paid out. Since workers compensation pays out for medical care and lost earnings, the amount they are entitled to collect can be substantial. That's why it's vital to hire an experienced personal injury attorney in Texas that knows how to negotiate with workers compensation carriers to reduce the amount of subrogation.

Personal Injury Attorney in Texas

In order to collect the largest possible amount of compensation, you need to hire a personal injury attorney in Texas that has the experience and know-how to negotiate subrogation claims on your behalf. The Morgan Legal Group is the leading personal injury law firm in Texas, offering free consultations for all types of personal injury cases, including car accidents, slip and falls, and dog bites. Call 713-969-5026 for a free case review.

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