There are many reasons why these claims have become so complex in Texas. To start, a medical malpractice case is much different than an 18-wheeler case or one involving a defective product, workers’ compensation, premises liability or, dangerous drugs and animals. Additionally, Texas leads the nation in “tort-reform” legislation which, among other things, has capped damages in certain types of cases. These laws have also put many procedural hurdles in place which makes it more difficult, time consuming and expensive to take a case from start to finish.
Texas also places the right of a health insurance company to be reimbursed ahead of the victim’s right to recover damages. This means that regardless of how bad the injuries are and, regardless of how much, or how little, money is able to be recovered, when a case settles, the health insurance company’s claim for subrogation has priority over the victim’s claim for damages. If the insurance company is not paid back, it can file a lawsuit against the client who was physically injured.
The type of health insurance coverage that a client has also plays a huge role in the reimbursement analysis. Different categories of health insurance are treated much differently under the law. Medicare is treated differently than a charitable health plan or a government plan or an employer sponsored self-funded plan or a more traditional premium-paid-for-insurance plan. And, depending on the type of plan involved, sometimes Texas state law applies and sometimes federal law applies.
To further complicate matters, there are usually several different types of insurance coverages which apply to any given case. Even in a clear liability, ran-the-red-light case, there are many different policies in play. These include the liability insurance of the negligent driver, health insurance of the victim and coverages under the victim’s own automobile policy including underinsured motorist coverage, personal injury protection coverage and medical payments coverage. Depending on the facts and damages of any given case, all of these coverages become intertwined and have a bearing on the reimbursement issues involved in the case along with the amount of damages that can actually be recovered.
Another trend that has developed in recent years is that more Texas hospitals are actually filing “liens” on cases even when the victim has health insurance. Regardless of whether the hospital should have filed the lien, the fact that it was filed creates problems in the case which must be addressed in order for the case to settle. This is because hospital liens under Texas law also have priority status like the health insurance claims and therefore, can lead to a suit against the client if the lien is not resolved.
There are many reasons why these claims have become so complex in Texas. The client reviews posted on the home page will let you know that you will receive the information needed to make informed decisions about your case. Free consultations are always provided. And while they are selective in the cases they accept, if they take yours, you will not have to pay an attorneys’ fee unless they win.