Cost Plus Plans and Your Car Wreck Case

North Carolina car wrecks: If your health insurance company paid your car accident-related medical bills, can it get money back from your settlement? “Cost Plus Plans”

North Carolina is an anti-subrogation state. What does that mean if you’ve been injured and you are trying to settle your car wreck case? What if your health insurance wants to be reimbursed for any medical bills it has paid out of your settlement?

North Carolina’s “anti-subrogation rule” means that privately funded health insurance policies in North Carolina will not be able to seek and receive reimbursement (also known as “subrogation”) from your personal injury recovery.

If an exception does not arise, health insurance plans generally cannot subrogate from auto insurance settlement proceeds. An alleged exception exists in “Cost Plus Plans” that are self-funded, administered on a county or city level, and claim a right of reimbursement from insurance proceeds recovered as a result of injury that the plan made payments toward. Cost Plus Plans allegedly derive their authority from N.C. Gen. Stat. § 58-65-135. It is to be noted that these “Cost Plus Plans are not a State Employee Health Plan which does have an established right of recovery.

Cost Plus Plans claim to circumvent North Carolina’s anti-subrogation rule by interpreting the following language to mean that the anti-subrogation rule does not apply to it: “the administration of any Cost Plus plans as herein provided shall not be subject to regulation or supervision by the Commissioner of Insurance.” In the alternative, this language could be read that “administration” applies to the daily administering of the plan: only that activity is not subject to the Insurance Commission. It should be noted that no court has ruled these plans are exempt from North Carolina’s anti-subrogation rule.

If you were injured in a car crash and your health plan claims you owe it money from the settlement, talk to an experienced personal injury attorney at Ward Black Law. We can help navigate this process for you to ensure you maximize your recovery. Call or text us at (336) 333-2244.