It is extremely important for you to see a doctor who is specially trained for accident injury to give you proper care and to manage your case.
For more information please click 'what to do' or call our office numbers.
Personal injury protection
Do I have to pay back my PIP coverage after I reimbursed by the liablity third party insurer?
In Maryland, there is a statute that denies a PIP insurer the right to subrogate or be reimbursed from a settlement or judgment. Maryland Insurance Code § 19-507(d) says:
(d) Subrogation. — An insurer that provides the benefits described in § 19-505 of this subtitle does not have a right of subrogation and does not have a claim against any other person or insurer to recover any benefits paid because of the alleged fault of the other person in causing or contributing to a motor vehicle accident.
(§ 19-505 is the statute that talks about PIP generally.)
So a PIP insurer does not have the right to be repaid from a liability insurer for the PIP benefits it pays out. This means that injured Maryland residents with PIP coverage can collect PIP under their own policy and the full amount of their damages from the wrongdoer.
However, if there are two PIP insurers (let’s say the owner’s policy and an injured passenger’s own policy), can the two PIP insurers subrogate against each other? Yes, they can, according to Bishop v. State Farm, 757 A.2d 783, 791 n.5 (Md. 2000). There is an order of priority among PIP insurers, with the vehicle’s insurance carrier bearing primary responsibility for PIP. Id. at 790. However, if the secondary PIP insurer paid benefits first, it could subrogate against the primary PIP carrier because it was not paying benefits “because of the alleged fault of the other person in causing or contributing to a motor vehicle accident.” § 19-507(d). Instead, the PIP insurers owe benefits just because an accident has happened, without any fault determination at all. Thus, the subrogation prohibition does not apply between PIP insurers, only between a PIP insurer and a liability insurer.
If you're lucky enough to live in Maryland, the HMO might not be able to collect anything from you.
A court there said, in Reimer v. Columbia Med. Plan, that since their enabling statute says that an HMO is a "prepaid plan", any payment other than premiums, deductibles, and co-payments is against the law. You might see how your own state's statute is written to see if you could make the same argument. It doesn't look as though it would apply in California.
I've recently (10/2000) heard, but don't know, that the Reimer decision was "overturned" by the Maryland legislature, so please verify that this is true for your case before relying on it.