Incurred vs. Paid
I have a car wreck case with surgery bills paid by health insurance. Health insurance disclaims subrogation. Liability carrier claims that means I have no medical damages, citing “paid versus incurred” statute. Is that right.
Answer: 12 O.S. 3009.1, the paid vs. incurred statute doesn't refer at all to subrogation. You're still entitled to recover your medical expenses even if the health insurance waives subrogation.
If the defendant can make the statute apply, you recover the amount the insurance company paid on the medical bills. Whether you have to share that with the health insurance company is of no moment to that statute.
You should also be aware that the defendant has to be able to produce a written statement from each health care provider that the health care provider will accept what the health insurance has paid as full satisfaction or the statute doesn't apply and you recover the full amount incurred. The statute says "If, in addition to evidence of payment, a signed statement acknowledged by the medical provider or an authorized representative that the provider in consideration of the patient's efforts to collect the funds to pay the provider, will accept the amount paid as full payment of the obligations is also admitted."
It's not always easy for the defendant to get that signed statement. Often the health care provider says something like "why should I sign that thing?"
This might actually be a great opportunity for you. Put the defendant under a time-limited, policy limits demand. If they fail to respond favorably in time, there's a reasonably good chance they will be liable for the excess judgment (amounts in excess of their policy limit) on a bad faith theory. If they think they don't have any liability for the medical bills, that could happen. You're a lucky man!
Posted on Mon, March 17, 2014
by Travis Law Office filed under