Do I Have to Pay Back My Health Insurance After a Car Accident?

Imagine you pay your health insurance premium every month. You also pay your auto insurance premium every month. Now imagine you are in a bad rear-end accident and are taken to the hospital in an ambulance. Chances are the hospital will "code" this is an accident which will tip off your insurance company that the treatment it is now paying for is attributable to some third party.

When your insurance company gets wind of the fact that this was a car accident they will probably ask you for some information about the other driver (i.e., the third party). The insurance company is likely to then insist that you pay them back for the money they spent for your care.

Under any scenario, the most you would pay back would be the actual amount of money spent on your behalf. If there is a limited amount of money to go around (for example, if the other driver had a small insurance policy and you had large medical bills) then the amount you might pay back depends on whether the plan is an ERISA (Employee Retirement Income Security Act) plan. A regular plan (for example, most Kaiser plans) calls for the insurer to get up to 1/3 of your recovery (if you have an attorney) or up to 1/2 your recovery (if you do not have any attorney). However, an ERISA plan is entitled to get back all of the money it spent - even if this means that you get nothing.

There are arguments to be made that you should pay less than the amounts set forth above. For more information, you should speak with a personal injury attorney.

Pete Clancy is a personal injury attorney in Oakland with a second office in Berkeley. He was named a "Rising Star" by SuperLawyers Magazine in 2010, 2011 and 2012.