What Is Subrogation, and How Does It Affect Your WA Personal Injury Settlement?

If you were injured due to someone else’s negligence, you may be entitled to compensation. You can use this compensation to pay for your medical bills, as well as any of the other damages you sustained due to this injury.

In the event that your insurer has already paid your medical bills, and you receive further compensation from the person responsible for your injury, you may be ordered to give up some of this further compensation.

Going over the basic facts of subrogation and how it can affect your WA personal injury settlement, while speaking with a personal injury lawyer, may help you obtain the compensation you’re entitled to.

What is subrogation? 

Subrogation is when an insurer seeks reimbursement for the medical and other expenses that it paid on behalf of an injured person, due to that injured person receiving compensation from a personal injury lawsuit.

Just as an example, if you are in a car accident and receive $35,000 from your insurer and then $70,000 from the driver who caused the accident, your insurer could try to obtain $35,000 from that settlement as reimbursement for the medical and other expenses they paid.

Subrogation can reduce the amount of compensation you hold onto after an injury, but only because it prevents you from recovering for the same losses twice. A personal injury lawyer can help you understand when subrogation might apply in your case.

How does subrogation work in WA?

In the state of Washington, subrogation tends to work in the following way:

• You are injured through no fault of your own and, as a result of this injury, sustain serious medical bills, as well as further damages.
• Your insurer pays for the damages you sustained, including your medical bills and anything else that their policy encompasses—damage to your car, for example.
• You receive this compensation before a finding of fault has been made, as per the terms of your insurance policy.
• You file a personal injury lawsuit against the party that caused your injury.
• You receive a settlement, which encompasses those medical bills, as well as damages beyond the scope of what your insurer already paid, from the party that caused your injury.
• Your insurer claims that they are entitled to the portion of that settlement as reimbursement for the medical bills their policy paid for.

Subrogation claims tend to be rooted in the following notions:

• Double recovery.
• The Made Whole Doctrine.

In the context of a personal injury lawsuit, double recovery is usually when you receive money for your medical bills from insurance and then receive money for those same now-paid medical bills from the at-fault party.

The Made Whole Doctrine is a doctrine stating that, within the context of a personal injury lawsuit, you can recover only after you are fully compensated for your total damages (not just medical bills), and typically must pay a pro rata share of your attorney fees/costs that produced the recovery.

Who is entitled to repayment due to subrogation?

The answer to this question is dependent on the party that compensated you, as well as the facts of your case. And, with this in mind, some of the parties that may be entitled to repayment, due to subrogation, are as follows:

• Your car insurance agency.
• A private health care policy you rely on.
• Medicaid, Medicare, or Medicare Advantage.
• A workers’ compensation program.
• Your ERISA health care plan.

If any one of these parties paid your medical bills, then they may be entitled to repayment. You may not have to repay these parties the full amount, though, depending on the overall facts of your personal injury case. Also note that government programs like Medicaid, Medicare, and workers’ compensation have specific statutory subrogation rules that differ from private insurers.

When does subrogation apply?

Subrogation applies when your insurer pays covered benefits and you later recover from the at-fault party. The scope and priority of reimbursement depend on the policy and Washington’s equitable rules.

Your insurer could be able to keep a portion of that compensation if they can prove that you have been fully compensated or compensated in excess.

How can a personal injury lawyer help you with subrogation?

Navigating subrogation policies

Many insurance companies have their own subrogation policy. These policies can greatly affect the amount of money you keep from a successful personal injury lawsuit.

A personal injury lawyer can help you with subrogation by walking you through the policies that these insurance companies may invoke to obtain some of the money you recover from a personal injury lawsuit.

Arguing that you were not fully compensated and did not receive excessive compensation

In the event that your personal injury lawsuit is successful, and you receive compensation that encompasses the medical expenses insurance already paid, your lawyer can argue that this compensation is not sufficient or in excess.

To argue this point, your personal injury lawyer could use expert witnesses, medical records, and eyewitness testimony to demonstrate that the compensation you received is not sufficient for the injuries you sustained due to long-term chronic pain or the trauma the injury caused, among other possibilities.

A successful argument can let you hold onto more of the compensation you receive. This is because, as per WA’s Made Whole Doctrine, insurance can only recover its costs if you have been fully compensated.

Obtaining compensation for your injury

Subrogation applies when you have already been compensated for your medical bills. As such, if your insurer pays your medical bills and you receive no further compensation, subrogation is unlikely to apply.

Your personal injury lawyer can help you file a lawsuit against the party at fault for your injury. By doing so, you can obtain compensation for all of the damages you sustained due to this party’s negligence. Obtaining this compensation can invoke subrogation. But, it can also do something else: give you the money you need to take care of all the other damages you sustained, including losses that didn’t come with a dollar sign, like your pain and suffering.

Contact a WA personal injury lawyer

Our personal injury legal team is ready to help you obtain the compensation you are owed. You can use this contact form to speak with one of Smith McBroom Injury and Accident Lawyers’s Seattle personal injury lawyers today. We are ready to help you.