During personal injury litigation, clients often face the decision of whether to use their health insurance for medical treatment or seek care from providers referred by their attorney. Healthcare providers referred by attorneys treat on a lien basis; that is, they agree to treat in exchange for a promise to be paid from the settlement or trial proceeds.
While lien-based treatment may be necessary in certain circumstances, our team from The Florida Law Group recommends that our clients use their health insurance whenever possible because it can bring convenience and benefits that lien-based treatments usually can’t.
Immediate Access to HealthCare
Health insurance typically provides access to a broad network of providers, more than the number of doctors available through an attorney referral. You can begin treatment immediately without waiting for lien arrangements or attorney referrals by going through your healthcare insurance, too. With prompt care and minimal upfront costs, you can reduce the risk of delays that could worsen your injuries and even weaken your injury claim.
For example, if the jury learns that there are gaps in your medical treatment schedule because you were waiting for a medical lien to be approved, they might be convinced that your delayed action worsened your injury, which would not be the fault of the defendant. Your personal injury attorney will want to give as little to the defendant’s legal team as possible to use against you, so getting immediate treatment through your healthcare insurance will be recommended in most cases.
Continuity of Care
Continuity of care is a critical component of effective medical treatment. By continuing to see existing healthcare providers, you benefit from a consistent treatment plan and a provider who is familiar with your medical history. This continuity can lead to better health outcomes and consistent medical records, which can help a case by showing the defendant, judge, and jury that you were serious about getting your injuries treated by a professional.
Stronger Case Credibility
Opposing or defendant counsel often challenge the legitimacy of lien-based treatment, arguing that:
- The medical bills are inflated.
- The treatment plan was litigation-driven rather than medically necessary.
Using health insurance can eliminate the chance of even making these arguments in the first place, potentially strengthening the credibility of your claim. Also, seeking timely treatment through health insurance demonstrates a proactive approach to mitigating injuries and damages that insurance adjusters and courts view favorably.
Juries generally perceive medical records and treatment obtained through health insurance as more credible because they see such records as independent and unbiased, as opposed to records from doctors who may have a perceived interest in the outcome of the litigation. Furthermore, lien-based treatment can reduce the credibility of the claim and lower the settlement or verdict amount because insurers or a jury may consider the bills inflated, which can affect their perception of the entire case. Using health insurance avoids arguments that a lien-holding healthcare provider has a vested interest in the outcome of the case that influences their medical opinion. This method also avoids problems when a doctor has not taken insurance in a case but in other situations takes insurance that pays at a lower rate in other situations, which tends to support the idea that charges are inflated.
Lower Medical Costs
Doctors hired through attorney referral may not take your health insurance, which would increase medical bills compared to doctors who take your health insurance. Health insurance companies often negotiate discounted rates with providers, so medical bills paid through insurance are typically much lower than those billed under a lien. On the other side, doctors who treat on a lien basis often charge higher rates than the “usual and customary” rates for treatment.
Lower medical charges can mean:
- Reduced lien size: Smaller liens or subrogation claims.
- Potentially better recoveries and compensation: Greater net recovery for our clients after settlement.
- Reduced financial stress: Health insurance can help cover the costs of emergency care, surgeries, physical therapy, and ongoing treatments, alleviating the burden of out-of-pocket expenses while the case progresses.
- More potential for maximizing settlement: Health insurers often negotiate discounted rates with healthcare providers, potentially reducing the overall medical costs and leaving more room in the settlement for other damages like lost wages and pain and suffering.
- Preserving credit and financial standing: Using health insurance can ensure that medical bills are paid promptly, safeguarding your credit score from potential collections or late fees.
- Managing subrogation: While health insurance companies may have subrogation rights (a right to be reimbursed for expenses paid out of settlement), an attorney can attempt to negotiate these liens to potentially reduce the amount you owe, allowing you to retain more of the settlement.
- Lower out-of-pocket costs: Utilizing health insurance can significantly reduce out-of-pocket expenses for our clients. Health insurance policies typically cover a substantial portion of medical costs, thereby minimizing the financial burden on our clients overall. By using in-network providers, our clients can take advantage of negotiated rates, which are often lower than the standard rates charged by out-of-network providers or those referred by attorneys.
- Simpler policy compliance: Health insurance policies often have specific requirements or benefits associated with using in-network providers. Our clients should be aware of these stipulations, as failing to adhere to them could result in denied claims or increased costs. Utilizing in-network providers improves compliance with policy terms and may maximize the benefits available under the health insurance policy.
Easier Negotiation of Health Insurance Liens
Health insurance liens (e.g., ERISA, Medicare, Medicaid) are often subject to statutory limitations and can be negotiated. In contrast, lien-based providers may be less flexible and demand full payment from the settlement.
Ethical & Legal Considerations
Referring clients to specific providers can raise concerns about conflicts of interest. Courts and bar associations have scrutinized such practices in the past. Encouraging our clients to use their own health insurance avoids these issues and aligns with best ethical practices.
There are important legal and ethical considerations when choosing healthcare providers in personal injury cases. Clients and attorneys must follow applicable laws and ethical standards. Using health insurance and in-network providers aligns with these considerations by promoting transparency and avoiding any appearance of impropriety.
Furthermore, what health insurance would have paid may be admissible even if it is not used. A referral to a doctor may also be admissible to the jury. In addition, the number of times attorneys have referred other clients to that healthcare provider and the healthcare provider’s total billings for those referrals may also be admissible.
This information may affect a jury’s perception of the propriety of the cost for treatment as well as the validity and necessity of treatment in the first place. Using health insurance bypasses questions as to whether a referral was made for the best medical interest or to support litigation.
Flexibility Regardless of Case Outcome
Regardless of the outcome of your personal injury claim, health insurance lets you get necessary medical care, protecting your health even if the lawsuit doesn't result in a favorable settlement.
Potential risks of attorney referrals include:
- Jury perception and credibility: If a case goes to trial, a jury may view attorney referrals to specific doctors with skepticism, potentially questioning the objectivity of medical records and testimony, and potentially impacting the outcome of the case.
- Insurance company tactics: Insurance adjusters might argue that treatment was influenced by the attorney-doctor relationship rather than medical necessity, potentially affecting settlement offers.
- Potential for conflicts of interest: Close relationships between attorneys and doctors could potentially lead to situations where the attorney's decisions are influenced by the relationship rather than solely by the client's best interests. Using doctors referred by attorneys can create potential conflicts of interest. Such referrals may be viewed as attempts to influence medical opinions or treatment plans to favor the litigation strategy.
When to Use a Medical Lien
You might want or need to use a medical lien in some situations, though. If you do not have health insurance, cannot access timely medical care through your insurance provider, or you need specialized treatment that is not covered in your policy, a medical lien might be the best option. Our attorneys can help you understand your options if you’re faced with any of these complexities.
When in Doubt About Healthcare Insurance or Liens, Ask a Lawyer
Using health insurance for medical treatment in personal injury cases is generally in the best interest of the client and the case. Doing so can reduce costs, enhance credibility, and avoid ethical pitfalls. At The Florida Law Group, we want our clients to prioritize their health and always seek immediate medical attention after an accident, regardless of their health insurance situation, of course, but that often means using healthcare insurance first.
If you have any questions about using healthcare insurance after being in an accident in Florida, you can bring your personal injury case to us. Our attorneys are ready to walk you through every step of the way, including not just litigation and casework but also figuring out the preferred way for you to get proper medical care. For more information about our legal services, call (833) 899-0310 or contact us online now.