U.S. Supreme Court Decision Affects Personal Injury Victims

April 18, 2013

THE FACTS

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.

THE CASE

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

1. 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 insurancecompany 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.

2. 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 goon 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.

3. This goes against our basic understanding of fairness and justice. The person who was impacted the most by the carelessness of someone else getsnothing (and in fact in this case owes the health insurer).
4. 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 pursuea 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.