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August 31, 2022 | Laws
If you sustain an injury caused by the negligent actions of someone else, there is a chance you will be able to recover compensation through an insurance settlement or personal injury jury verdict against that party. However, in the meantime, there may be various parties that help pay your medical bills while the claim is ongoing. These other parties, often insurance carriers or medical agencies, will typically have the right to recover compensation from the final settlement or jury verdict for the money that they have put in so far. This is called subrogation.
Subrogation is a confusing topic for many people because it is not a word that is in our everyday vernacular. In West Virginia, subrogation can apply when an insurance carrier helps make payments to a person who has sustained an injury due to the careless or negligent actions of someone else. In many cases, even though a person will be entitled to compensation recovery through an insurance settlement or a personal injury lawsuit against the at-fault party, they will not have the money to pay for their medical expenses right away.
If a person has to turn to their own insurance carrier, perhaps their own private health insurance carrier or their auto insurance, there’s often a subrogation clause written into the insurance policy. This means that the insurance carrier that covers the expenses in the short term will typically be entitled to recover compensation from the other party, in this case, the at-fault party that caused the injury.
Some of the most common types of insurance payments that get made after an injury occurs that may be entitled to subrogation include:
Under West Virginia law, there are some stipulations on the subrogation rights of the insurer. In the absence of a clear contract agreement regarding subrogation in the insurance policy, the “Made Whole” doctrine will apply. What this means is that the injured party, the insured, must be completely compensated before the insurance carrier can enact their right to subrogation against any monies that come in from an insurance settlement or personal injury jury verdict.
Under this doctrine, a person could say that they have not been made whole as a result of the settlement and should therefore not have to repay the insurance that covered their expenses in the interim. In these cases, the court can choose to hold a hearing to determine the true value of the claim. If a person receives a settlement that is only 10% of the value of what their claim should have been, then the insurance carriers would likely only be able to recover 10% of the payments they made through subrogation.