this is crazy..

[dispatcher]

http://articles.moneycentral.msn.com/Insurance/KnowYourRights/EmployersGrabAccidentVictimsCash.aspx

[Unicornmom77]

Employers grab accident victims' cash


Wal-Mart's health plan sued an ex-worker, brain-damaged in a crash, to collect money from a settlement she'd received. It's part of a trend in which companies aggressively try to recoup insurance costs.

A collision with a tractor-trailer seven years ago left 52-year-old Deborah Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, and three sons found a small source of solace: a $700,000 accident settlement from the trucking company involved.

After legal fees and other expenses, the remaining $417,000 was put in a special trust. It was to be used for Deborah Shank's care.

Instead, all of it is now slated to go to Deborah's former employer, Wal-Mart Stores.

Two years ago, the retail giant's health plan sued the Shanks for the $470,000 it had spent on her medical care. A federal judge ruled last year in Wal-Mart's favor, backed by an appeals-court decision in August. Now, Deborah's family has to rely on Medicaid and her Social Security payments to keep up her round-the-clock care.

"I don't understand why they need to do this," says Jim Shank on a recent visit to the nursing home, between shifts as a maintenance worker and running a tanning salon. "This girl needs the money more than they do."

Deborah, who needs help with eating and other basic tasks, has spent more time alone since Jim had to let her private caregiver go. At some point, he says, she may have to be moved from a private to a semiprivate room in the nursing home where she lives.

The reason is a clause in Wal-Mart's health plan that Deborah Shank didn't notice when she started stocking shelves at a nearby store eight years ago. Like most company health plans, Wal-Mart's reserves the right to recoup the medical expenses it paid for someone's treatment if the person also collects damages in an injury suit.
Deborah and Jim Shank © Vanessa Fuhrmans / The Wall Street Journal

Until recently, many employers didn't vigilantly enforce the provision, and some states and federal courts didn't think the claim held water. But as the cost of covering workers continues to escalate, employers and health plans are getting more aggressive about going after the money. A U.S. Supreme Court ruling last year also has given them a clearer legal map to suing employees and winning.

In insurance circles, the recovery practice is called "subrogation." Employers and insurers say it's necessary to ensure that medical expenses aren't paid twice. By recovering those costs from someone who's been compensated elsewhere, they argue, they're saving money for everyone on the plan.

Sharon Weber, a spokeswoman for Wal-Mart, declined to discuss the details of the Shanks' case, but she said the company was obliged to act in the interest of the health benefits of its employees as a whole. "While the case involves a tragic situation, our responsibility is to follow the provisions of the (company health) plan which governs the health benefits of our associates," she said.

"Employers are trying to make sure these plans run as efficiently as possible," says Jay Kirschbaum, a senior vice president at global insurance broker Willis Group Holdings. "They also have a fiduciary duty to the plan and the entire group of employees that are covered by it."
The recovery practice
Already, the recovery practice is one of the variables that plaintiffs lawyers are considering as they decide whether it's in their clients' interests to participate in the $5 billion offered by Merck to settle lawsuits over its painkiller Vioxx.

Health plans recovered sizable amounts for medical expenses from other big product-liability settlements, such as for the "fen-phen" diet-drug combination and Sulzer Orthopedics' hip implants. Many insurers and the employer plans they administer are expected to pursue a piece of the Vioxx settlement.

[MoOn-BaBy]

simply disgusting they would do that to that poor woman!:mad:

[kelblend]

Years ago my husband and I were in a car accident. We had to go to the chiropractor for awhile. When our settlement came in I didn't know I had to pay anything back to the insurance company. Sure enough,though, we ended up having to pay back $1000 each. I thought it sucked, but this instance of it is just horrible.

[gmyers]

It seems like this is going to get people not to sue when they're hurt. Between the lawyer fee and what they took theres nothing left for her. And then to add insult to injury she has to pay court costs too. If they're going to get the money the least they could do is pay court costs. I don't see how they live with themselves. I still say all the premiums they paid should cover what the insurance company had to pay out. It seems like they're double dipping getting the premiums and then getting the settlement too. Whats the use of having insurance if you have to pay them back when you file a claim.

[SLance68]

This happens all the time not just Wal-Mart's insurance. And it has NEVER stopped anyone from filing a lawsuit. People just look at that big number they think they are going to get - well the insurance company should have not had to pay for the injuries since they were the responsibility of another party. Think about your car insurance if you get in a accident and it is someone else's fault - your insurance might pay to have your car fixed but they go after the other insurance carrier for reimbursement. Same thing it is just one is related to a lawsuit and one is a car accident. And if you really look it is the attorneys that get the biggest chunk of the money.

[tngirl]

This is the reason why when you go to the doctor or ER they ask you if your illness/injury is work or accident related. I have never known an insurance company that covers injuries that should be covered by another insurance company. Just like with your car insurance, they may pay up front but they go after the other insurance company for reinbursement. Yeah, it sucks, but if you think about it, they shouldn't be responsible for car accidents and such, it is health insurance.

[Shann]

yep... when I was in a car accident that was not my fault my insurance wouldn't cover it. I had to pay for my full medical bills and be reimbursed by the butt monkey's insurance who hit me.

[ma4angels]

I just left this in News thread. I understand they shouldn't have to pay when it is someone elses fault. Suppose the person at fault is common enough not to have insurance what then. Are you suppose to pay all the insurance payments and not be covered? Are you suppose to lose everything to the hospital then. What a world we live in. Like I said in the other thread, Why does Wal-mart a billion dollar company feel the need to take this women's money that is caring for her away. They are common. She was paying her insurance didn't they get that from her. When I worked there years ago they had crappy insurance anyway. You paid through the nose for it and it never would pay out. I am surprise they even paid for her bills to start with

[pepperpot]

yep... when I was in a car accident that was not my fault my insurance wouldn't cover it. I had to pay for my full medical bills and be reimbursed by the butt monkey's insurance who hit me.

Okay, so when your 'walmart' insurance pays your bills, and then monkey butt 'reimburses you'.....what are they 'reimbursing' you for? (wallmart paid the bills)? Walmart was only going after the 'reimbursement'.....of what they paid for....

[pepperpot]

I just left this in News thread. I understand they shouldn't have to pay when it is someone elses fault. Suppose the person at fault is common enough not to have insurance what then. Are you suppose to pay all the insurance payments and not be covered? Are you suppose to lose everything to the hospital then. What a world we live in. Like I said in the other thread, Why does Wal-mart a billion dollar company feel the need to take this women's money that is caring for her away. They are common. She was paying her insurance didn't they get that from her. When I worked there years ago they had crappy insurance anyway. You paid through the nose for it and it never would pay out. I am surprise they even paid for her bills to start with

Well then, if you are unable to sue the 'common person' or do not get an 'award'....then 'Walmart" would not go after you.....they are going after the 'award' from a suit for bills they have paid whose liability is the 'common person'/insurance company which you have collected from.

[pepperpot]

This is the reason why when you go to the doctor or ER they ask you if your illness/injury is work or accident related. I have never known an insurance company that covers injuries that should be covered by another insurance company. Just like with your car insurance, they may pay up front but they go after the other insurance company for reinbursement. Yeah, it sucks, but if you think about it, they shouldn't be responsible for car accidents and such, it is health insurance.

yup....BTW Merry Christmas :)

[ma4angels]

Well then, if you are unable to sue the 'common person' or do not get an 'award'....then 'Walmart" would not go after you.....they are going after the 'award' from a suit for bills they have paid whose liability is the 'common person'/insurance company which you have collected from.

I was talking about my personal experience with Walmart insurance and of course others talking about their insurance not covering auto accidents. That is what meant about owing the hospital everything I know that if the common person doesn't have insurance you can't sue. I am not totally stupid. I really don't care if they are going after the liability it is wrong. Wal-mart could have sued the person at fault for the bills too instead of taking away the money that was taking care of this women.

[pepperpot]

I was talking about my personal experience with Walmart insurance and of course others talking about their insurance not covering auto accidents. That is what meant about owing the hospital everything I know that if the common person doesn't have insurance you can't sue. I am not totally stupid. I really don't care if they are going after the liability it is wrong. Wal-mart could have sued the person at fault for the bills too instead of taking away the money that was taking care of this women.

I never claimed you were stupid but now I'm confused because of all the scenarios of whom we are actually talking about......

Person in article. Truck hit her, Walmart paid medical bills (should have been processed through trucker's insurance, wasn't), she settles suit with trucker for bills, pain, suffering, future care, etc. Walmart goes after portion of settlement allotted for the 'bills'.....that seems fair.

If Walmart were to then sue the truck company/insurance for bills, they already paid the woman for those bills.

I absolutely feels sorry for this woman in horrible shape with limited income, but Walmart really isn't the bad guy here.

*****
2nd scenarios - the common person (he causes accident, has no insurance), the victim works at Walmart. The common person does not have insurance in which to submit your (victim's) medical bills to, Walmart kicks back your (victim) bills and says this is not our (Walmart's) liability, go after the other driver.....the hospital says, "I want to get paid", so you (victim) pays bills from your (victim) pocket. The victim pays his own bills. :(

If the common person does not have any assets to attach for you to recoup your losses (med bills).....that stinks but it is not walmart's responsibility. That common person is the culprit and should be brought up on charges and sued for breaking the law.....driving without insurance.....unfortunately you (victim) gets the short end of the stick, but it is the common person's fault and responsibility.

*******

Do I have the stories correct now?

P.S. I'm not a Walmart fan myslef, I'm just trying to be objective.

[SLance68]

I was talking about my personal experience with Walmart insurance and of course others talking about their insurance not covering auto accidents. That is what meant about owing the hospital everything I know that if the common person doesn't have insurance you can't sue. I am not totally stupid. I really don't care if they are going after the liability it is wrong. Wal-mart could have sued the person at fault for the bills too instead of taking away the money that was taking care of this women.

The reason that Wal-Mart Insurance attached to the lawsuit is because that is how the Tort laws are written. Wal-Mart Insurance cannot sue separately if the victim is suing - they are only allowed to attach a claim onto the lawsuit. That is just how the laws in this country are written and Wal-Mart Insurance was just following the laws of this country. HTH

[chazsgirl]

what a bunch of jerks!

[Shann]

Okay, so when your 'walmart' insurance pays your bills, and then monkey butt 'reimburses you'.....what are they 'reimbursing' you for? (wallmart paid the bills)? Walmart was only going after the 'reimbursement'.....of what they paid for....

I was replying to tn's post, sorry... my post doesn't make sense with the original post. :o My insurance would not cover any of my med bills b/c it was at fault of someone else. I'm shocked that walmart did, but I can see why they are going after that money.

[MsLynn]

i've only had one major accident, and i made sure, THEY PAID MEDICAL BILLS, PLUS,,, the few bucks they gave me.

[tracey74]

I watched this story on the today show the guy actually had to divorce his wife just so she could get more money for her disability and so her dr bills and stuff would be taken care of. he was on with his son and his lawyer