by savealot64 » Fri Jan 29, 2010 09:50 pm
My wife and I were involved in a motorcycle accident. The party that pulled out in front of us were charged with being 100% at fault.Our personal health insurance paid all med bills except the deductable. total med bills were about $20,000.We settled with the isurance co. of the driver at fault for $66,000 with an attorney.The attorney recieved the check for $66,000 he mailed it to us, we signed it mailed it back waithing for our $43,000 portion of it (66%).Before they could mail out our portion my health insurance contacted the attorneyt wanting reimbursment on the med pay. The attorney told us before settling that they can't do that as Missouri is a double dip state. That is why we settled for the amount we did. Now the attorney says we can't recieve out settlement until the matter is cleared up with the health insurance co. because they are afraid of malpractive suit from the insurance co.Can they do this? Did they give me bad advice?Do I have any way to make them pay me the settlement money?thanks steve
Posted: Fri Jan 29, 2010 10:09 pm Post Subject:
The attorney told us before settling that they can't do that as Missouri is a double dip state
Well you paid 33.3% to a MO attorney that does NOT understand what a double dip state is! and I'd be plenty pissed if I were you....I've been an adjuster in MO for well over 20years...Double dipping (as it pertains to MO law) means you can be paid by the at fault party (the 66k) and your own AUTO MED PAY coverage (if you have it)...it does NOT pertain to health coverage..
Can they do this?
They already did!Did they give me bad advice?
You bet your 33.3 % they did!Do I have any way to make them pay me the settlement money?
make who pay it your attoreny? good luck...attorneys don't give up money easily...and I'm betting you can't prove that he told you that right?because they are afraid of malpractive suit from the insurance co
That doesn't make any sense how on earth could either of the ins companys file a malpractice suit against him? They can't! But you can! This is all BS...he's just trying to get the monkey off his back...I would tell him that you've done some research and it has been this way for at least 20years, (probably forever), and you paid him a BIG fee to give you legal advise for the state that HE practices in! So he can either figure out a way to get your health carrier to to release their lein...or you expect at least 66.6% of his $21,978.00 that you've paid him for this 'advise' (or $14,637.35) to go toward that $20,000.00 and you'll pick up the other third..or you will file a complaint with the MO Bar association, and then file a malpractice suit yourself!
Another thing Steve, were the bills $20,000.00 or is this the amount your health provider paid? Generally health carriers get discounts..but the at fault party would've owed you the actual charges..do you understand what I mean..Like if you go to the ER say the bill is 5k, but the hospital writes off (lets say) 2k, due to an agreement your health carrier has with them...so in this example the at fault party would owe you 5k, but you would only owe your health carrier 3k...
Are you asking if there is a way to make your attorney release your settlement? There is no reason he cannot release the amount that is not in question...so 20k off of what you have coming...he can have no reason to not release that..
Posted: Fri Jan 29, 2010 10:13 pm Post Subject:
this was total billed, I will need to get my paper work from the insurance to see exactly how much they actually paid.
steve
Posted: Fri Jan 29, 2010 10:15 pm Post Subject:
Do that because they can only subrogate you for the actual amount that they paid out.
How long has this attorney been practicing?
Posted: Fri Jan 29, 2010 10:35 pm Post Subject:
my attorney says that inthe state of Missouri they have no right to subrogate, even if it is health insurance.
He is holding my money in a trust account because of the guide lines set forth by his malpractice insurance.
He has been practicing for 30+ years as a well known personal injury attorney.
Although his Legal Assistant is the only person with the firm I have delt with, I assume because he doesnt have time for little settlements like mine.
His legal assitant says 99.9% chance I will get my money but because of malpractce insurance guidelines they cant release it until the matter is settled.
thanks steve
Posted: Fri Jan 29, 2010 10:46 pm Post Subject:
my attorney says that inthe state of Missouri they have no right to subrogate, even if it is health insurance
he's (or the paralegal is who ever told you this) wrong.That makes MUCH more sense about the malpractice policy, not suit...
Posted: Fri Jan 29, 2010 11:13 pm Post Subject:
I found this in lawyersandsettlements.com does this apply to me?
Commercial health insurance is regulated by states, and most states don't allow 100 percent subrogation; some allow some reimbursement, but generally the insured must be made whole first. However, if you create an ERISA insurance plan and allow it to provide coverage, ERISA pre-empts the state insurance codes, the state rules are thrown out, and the plans can write their own rules unbound by regulation at either the federal or state level.
So, for example, the Missouri state insurance code totally disallows subrogation. That means that in the Debby Shank case, Wal-Mart would have gotten zero if they had sued in state court; the only reason they got anything was because she was covered by an ERISA plan.
steve
Posted: Sat Jan 30, 2010 05:30 am Post Subject:
Let me see if I have this correct.... his contact with his E&O carrier states that the settlement amount needs to be set aside. Okay... when did you become a party to this contract? Your contract with the attorney says he takes 33% of your settlement and you both go your separate ways. IMHO, he CAN'T hold onto _your_ money because he might have made a mistake. If he wants, he can feel free to put his own money in an account to address his possible mistake. I think you are being lied to about this. He's holding _your_ money in case he made a mistake and your health carrier comes back and wants their money. That way he can then use _your_ money to pay them off and protect himself from his mistake. He made the settlement base on his thought that your health carrier could not come back and take any portion of it. Part of his 33% fee should be to back up his understanding and protect your interest that he was representing and you were paying for. It's like me hiring an attorney to do my taxes. I'm paying him to get it right. If he screws up and I owe penalties then he should pay the penalties out of his pocket as I was paying him to get my taxes right. He should not hold my return in his account in case he needs to pay those penalties for me.
You may want to speak to another attorney about this matter. Your only problem is it would be another plaintiff attorney and most tend not to go against their own.
Posted: Sat Jan 30, 2010 12:24 pm Post Subject:
If he wants, he can feel free to put his own money in an account to address his possible mistake. I think you are being lied to about this
I couldn't agree more..That way he can then use _your_ money to pay them off and protect himself from his mistake
EXACTLYI found this in lawyersandsettlements.com does this apply to me?
yes, and no...see this part here..but generally the insured must be made whole first
This means you'd have to PROVE that you are OUT more than 66k...don't think you can...ANDHowever, if you create an ERISA insurance plan and allow it to provide coverage, ERISA pre-empts the state insurance codes, the state rules are thrown out, and the plans can write their own rules unbound by regulation at either the federal or state level.
Is your heath insurance thru your employer by chance?Posted: Thu Aug 18, 2011 04:51 pm Post Subject: question about double dipping in MO
Can all parties involved in the accident double dip or only the driver of the vehicle???
Posted: Fri Aug 19, 2011 09:31 am Post Subject:
I guess the US laws don't allow you to enjoy double benefits for the same reasons. You may collect it from your own insurer, and your own insurer might just recover it form the at fault party's insurer. This is known as subrogation.
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