A Healthy Health Fund

Michael Riegert

For a trustee of a health fund, it is important to know when the fund should seek reimbursement from others for the medical benefits the Fund has expended.  This is known as subrogation.  Typically, subrogation rights arise when an injury is the fault of another.  Injuries from a car accident would be an example.  However, subrogation rights are always dependent on the facts and circumstances of each injury as well as applicable laws.

Many times it is not readily apparent if there is a subrogation claim.  In fact, many times it may appear to the untrained eye that there is no subrogation.  Take for example an eight year old playing in her backyard.  She loses her balance and falls breaking her wrist.  Here, the subrogation claim is not apparent.  When she receives medical treatment, the health fund processes the claim and learns that she hurt herself playing in her own backyard.  That would typically be the end of the claim for the Fund.

However, upon investigation by the Previant Law Firm, we might learn that the eight year old tripped over a tool that had been left behind by a landscaper who had recently done some work at her home.  The landscaper’s negligence in leaving tools and/or materials behind on the lawn, bushes, or anywhere would allow a claim for reimbursement from the landscaper to the Fund.  Such claims have been successfully pursued by our firm resulting in a recovery to the Fund and the injured person.