Judge Slams His Gavel and American Flag Table Reflection.Subrogation refers to a legal doctrine where one party is allowed to recoup monetary funds for another after having fronted costs. Typically, subrogation is used to refer to the rights of insurance companies, who will often pay for patients’ services up front, but then are later entitled to recover costs if the plaintiff wins a lawsuit. However, a recent decision made by the U.S. Supreme Court may change this, allowing plaintiffs in medical malpractice actions (and other personal injury lawsuits) to keep a greater percentage of their winnings.

The Case That May Change Everything


The Supreme Court case is Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, and the basics of the case are thus:


In 2008, the plaintiff in the case – Robert Montanile – was hit by a drunk driver and sustained serious injuries. His health plan – National Elevator Industry Health Benefit Plan – paid for his surgeries, which totaled $121,044.


In a civil action against the drunk driver, Montaile won a settlement of $500,000. He paid his lawyers $263,788; he had $236,212 left. But, under subrogation, the health insurance company was entitled to reimbursement for the full amount – $121,044, which means Montanile would have only been left with $115,168. (The argument for subrogation in a case such as this is that if the plaintiff does not pay the health insurance company, he is essentially being allowed to collect damages for the same expense twice).


Montanile attempted to negotiate with the health plan, and his new lawyer told the health plan that if they didn’t hear from them within two weeks’ time, he would release the remaining settlement money to Montanile. The health plan didn’t respond, and Montaile received the money. Then, the health plan sued Montanile.


The Court’s Decision


In the end, the Supreme Court decided that the health plan could not reimburse itself from Montanile’s general assets (at this point, Montanile had spent most of the settlement money), reversing the decision of a lower court. According to an article in NPR News, the basis of the court’s decision was that if the health plan had acted more quickly, it may have been able to recover the funds it was entitled to.


The takeaway is this: while many states already have laws on the books that allow consumers to recover all of the money they are entitled to for damages, including pain and suffering, before insurance companies can be repaid, these laws do not apply to self-insured companies. The Supreme Court’s decision may mean two things for plaintiffs: that the odds of winning a larger settlement award are improved, and that health plans will work quicker to negotiate and settle after a case.


Contact Our Boston Medical Malpractice Attorneys Today


If you believe that you have a medical malpractice lawsuit, the attorneys at Lovenberg & Associates, P.C. can help you. Our experienced team knows how to fight for the damages you deserve. Call us today at 617-973-9950.