You have to be kidding me...
I received a Certificate Rider from my HR rep today that states the following:
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The following Subrogation and Right of Reimbursement section has been added to the General Information About Your Coverage section of your Booklet-Certificate:
Subrogation and Right of Reimbursement
If this Plan pays benefits under this Booklet-Certificate to a covered person for expenses incurred due to third party injuries, the Aetna retains the right to repayment of the full cost of all benefits provided by this Plan on behalf of the covered person that are associated with the third party injuries. Aetna's rights of recovery apply to any recoveries made by or on behalf of the covered person from the following sources, including but not limited to:
- payments made by a third party or any insurance company on behalf of the third party;
- any payments or awards under an uninsured or underinsured motorist coverage policy;
- any Workers' Compensation or disability award settlement
- medical payments coverage under any automobile policy, premises or homeowners' medical payments coverage or premises or homeowners' insurance coverage; and
- any other payments from a source intended to compensates a covered person for injuries resulting from an accident or alleged negligence.
By accepting benefits under this plan......
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How I read this?
I get hit by a car, trip and fall, have a piano fall on me, dog bite,... and need medical care my insurance company will cover those expenses. Great!
Here is what I don't like. I'm maimed, traumatized, scarred, and gimped for the remainder of my life. I can't work, walk, whatever.
I sue. It is the American way. I sue the driver, his insurance company, the landlord, his insurance company, the piano movers, his insurance company, the dog, his owner, his insurance company (you get the point).
I win a settlement, someone offers to pay me for my trouble, and or I'm on Workers Comp.
Aetna will sue for that money up to the amount it cost to patch me up.
I need $50,000.00 in medical care & Aetna pays. This is how insurance works. This is what the premiums have been going into an interest bearing account for. But they have gotten greedy and want to be reimbursed for this.
Example
I'm awarded $50,000.00 from the courts. I pay my lawyer the typical 30% or $15,000.00, then Aetna takes the remaining $35,000.00. This leaves me with nothing. According to the Rider, Aetna can also take my Workers Compensation for the remaining $15,000.00
This leaves me maimed, traumatized, scarred, gimped and broke.
Aetna, I'm glad I met ya!
posted by the_ubster @ 9:28 AM
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