Margarita’s Stockton Auto Accident Attorney

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“Mr. Gutierrez was extremely nice and helpful. He listened to everything that happened the day of the accident. [Everyone] cared about my case and helped make accommodations for me when needed. Very professional. We fought for the highest amount and I am extremely happy Mr. Gutierrez helped me with that. I am so glad I decided to go with these attorneys. They know exactly what they are doing and are passionate about it. They are great!”
Margarita, Stockton

Can My Medical Insurance Company Take Part Of My Settlement?

Can My Medical Insurance Company Take Part Of My Settlement?

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Why do I have to use money received from my settlement recovery or judgment to pay back my health insurance company when I pay monthly health insurance premiums? The money is mine.  I am the injured victim.  I took the time to hire an attorney and prosecute my case.  I filled out the paperwork, worked with my attorney, and went to court.  Plus, I already paid for my medical treatment through my premiums.  My health insurance company should get nothing more.

We receive these questions and comments every day from our clients, and you are not alone if you are critical of this aspect of our justice system. It makes common sense.  The health insurer already has been paid by you to pay for medical services needed by you.  Why should they receive your premiums and in additional get reimbursed from your personal injury recovery?  If you had been injured by your own fault, then the health insurance company would not have been able to receive any additional money.

However, the health insurance industry takes a different stance. The health insurer had to pay out for your medical treatment so the health insurer believes it too has been injured by the party that injured you.  After all, if you hadn’t been injured, then they would have saved money on medical expenses.  Therefore, if you recover money for your medical treatment, then the health insurer wants it.

In an effort to get recoup their losses, the private health insurance industry has found a clever way to gain reimbursement for money expended for your medical treatment when someone else caused you to be injured. Typically, when you sign up for private medical insurance, you have to review and sign documents.  As part of those documents, you typically agree to notify the medical insurer when you are injured in an accident and are seeking recovery against someone else or someone else’s liability insurance company.   You then agree to reimburse your health insurance company from proceeds received from a settlement, judgment or award.  The health insurer’s right of reimbursement is a condition of your health insurance policy.

Indeed, you have signed a contract agreeing to reimburse your health insurance company from any recovery received for your injuries.   Of course, this reimbursement is limited to what the health insurance company actually paid out in treatment.

The health insurance industry will certainly contend that it counts on these reimbursements in order to keep health insurance premiums lower for all of its members.

Now, there is some good news for you. You will not have to use all of your recovery to pay back the health insurance company but that depends on the type of health insurance plan you are participating in.

California Civil Code section 3040 limits a private health insurance company from receiving a full reimbursement.   You should consult with an attorney to calculate the reductions as there are different factors that must be taken into consideration.  An attorney can also make some equitable arguments to a health insurer in order to reduce the reimbursement obligation.

You should know that Medi-Cal, Medicare, and employer-sponsored health plans, commonly known as ERISA plans, have separate rules that govern their reimbursement rights.

Fortunately, the personal injury attorneys at Curtis Legal Group can help you prosecute your case and then help you negotiate with your health insurance company once you receive a recovery.

Modesto Shooting Incident Uninsured Motorist Settlement

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The firm’s client was driving a rental car when shots rang out from a passing vehicle. The client was wounded and his passenger was killed. The shooter was eventually sentenced to 17 years in prison. After repeated denials of coverage and liability from several insurance carriers, the firm was able to obtain a $100,000 uninsured motorist policy limit settlement for the client.

Sacramento Driver and Passenger Car Accident Recovery

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Our clients, a driver and two passengers, were driving along a state route highway when suddenly another vehicle came crashing across the highway landing on their vehicle. That car had been rear ended by another motor vehicle causing it to careen out of control. Our clients suffered serious orthopedic injuries. Curtis Legal Group fought for its clients against other injured parties. As a result, Curtis Legal Group was able to obtain $250,000.00 for its clients.

Sacramento Passenger Car Accident Settlement

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Our client was a passenger in a vehicle making a left turn at an intersection. Another vehicle came speeding into the intersection from the opposite direction, running the red light and crashing into our client’s car. Our client suffered neck and back injuries. We were able to help her get much needed medical treatment even though she had no medical insurance. We filed a lawsuit on her behalf and were able to settle her case at a mediation for $385,000.

Sacramento Trip and Fall Accident Settlement

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Our client tripped and fell in a city crosswalk causing our client to develop chronic regional pain syndrome. The crosswalk was in disrepair, and Curtis Legal Group contended that the crosswalk was a dangerous condition. As a result of the fall, our client suffered from chronic pain that prevented our client from engaging in normal activities as well as walking for extended periods. Our client required a lifetime of medication to help with the chronic pain. Curtis Legal Group was able to recover almost $1,000,000.00 for this client.

Stockton Truck Accident Settlement

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We represented the widow and adult children of a gentleman who was driving a truck on a rural country road. Another truck, towing a trailer loaded with a piece of farm equipment, approached from the opposite direction. The truck towing the farm equipment veered slightly over the center line and the farm equipment caught the wheel of the first truck, causing it to go out of control and crash, killing our clients’ husband and father. We were able to get involved in the case right away and had a full on scene investigation accomplished, which included an expert in accident reconstruction. Skid marks were still visible and were helpful, along with measurements and photographs at the scene, in demonstrating how the accident occurred. The case went into litigation and ultimately settled for the available insurance policy limits of $2,500,000. We were able to assist in getting a portion of the settlement money invested so that the decedent’s widow was provided with lifetime financial security.

Stockton Car Accident Recovery

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Our client lived with her mother part-time and also lived on her own. She was a passenger in a motor vehicle accident where she suffered severe injuries requiring neck surgery. The driver of the automobile in which she was a passenger was found to be a fault for the accident. However, the driver did not have sufficient insurance to cover our client’s injuries. Our client turned to her mother’s underinsured motorist coverage, but her mother’s insurance company contended that she was not a resident of her mother’s household so she could not recover. We fought this coverage denial and proved that our client maintained a “dual residency”. A “dual residency” would provide coverage under her mother’s uninsured motorist benefits. The insurance company agreed and settled this matter thereby providing underinsured motorist benefits to our client. We recovered an additional $100,000.00 for our client that she would not have received without our legal advocacy and research.

Modesto Slip and Fall Accident

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Our client slipped on water leaking from an ice machine as she walked along a common area walkway to a retail store. She suffered a severe foot injury requiring two surgeries. Our client sued the owner of the retail shopping mall since the accident occurred in a common area of the center. She also sued the owner of the ice machine and the retail store associated with the ice machine. The defendants claimed that our client was distracted and failed to notice the water. We claimed that the defendants failed to warn our client, a customer, of the wet conditions. Each side blamed the other and extended the litigation in this matter. We were ultimately able to settle this case for $300,000.00.

Sacramento Car Accident Settlement

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Our client was a front-seat passenger in a motor vehicle that crashed into another car and rolled over. The driver of that vehicle was distracted and crossed the center line causing a head-on collision. As a result, our client suffered significant injuries and was left permanently disabled. The at-fault driver had a small insurance policy covering him for our client’s injuries, and he had no assets. Our client sought our firm’s help. We discovered that the driver was attending a family weekend event and was an employee of his parents’ business. We were able to argue that the family’s business automobile policy covered the at-fault driver since he was driving the motor vehicle for the personal affairs of the family business. We were able to settle the case for approximately $350,000.00. Our efforts also allowed more insurance funds to be available to the driver and passengers in the other car.