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Personal Injury Settlement in Missouri: Can Your Health Insurer Demand Payback for Medical Expenses?

By Benjamin J. Sansone, Esq.

Previously, I discussed recovery by 3rd parties against Missouri wrongful death settlements or judgments regarding medicare and also health care providers.

How about cases not involving wrongful death? Lets say you are involved in a Missouri auto accident with injuries and your health insurance, that you pay for, covers your medical expenses. Can that heath insurer now demand you pay them back from the proceeds of your auto accident settlement or judgment against the at fault driver? Absolutely not - but they try all the time.

As a St Louis Missouri lawyer with my primary practice focusing on all personal injury cases, I run in to this issue from time to time. Just recently, I had Blue Cross Blue Shield try and claim a lien and subrogation right against my client's money damages recovery against an at fault driver in a St Louis car collision lawsuit.

Under Missouri injury law it is clear that a lien or subrogation claim by a health insurer is against public policy. This standard under Missouri injury law has held since 1965 in the case of Travelers Indemnity Co. v. Chumbley, 394, S.W.2d 418, 425 (Mo.App.1965).

"It is also clear that a health care insurer may not be subrogated to its insured's right to recover from a third party tort-feasor because it would constitute an impermissible partial assignment of the insured's action for damages for bodily injury"

See Schweiss v. Sisters of Mercy, St. Louis, Inc., 950 SW 2d 537 (MO CT APP ED 1997) citing the Travelers case.

Also see Missouri injury lawsuit - Scroggins v. Red Lobster, No. SD 30214 Court of Appeals, Southern Dist 2010 stating:

?The Participant paid for health care coverage. The Insurer was obligated to provide those benefits regardless of whether the Participant pursued her personal injury claim. Missouri courts have never allowed a provider to be reimbursed for medical expenses that the insured recovers in a settlement from a liable third party under a lien theory, and we decline to do so now.?

Full post as published by Missouri Injury Law Blog on December 14, 2010 (boomark / email).