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Subrogation
 
The Subrogation team is involved in situations when a member is injured in an accident or event where there may be a third party at fault. Below is a description of the most common examples of cases handled by the Subrogation team.
 
Auto Accidents

Subrogation reviews the circumstances of all auto accidents, any type of motorized vehicle accidents, and auto vs. pedestrian or bike accidents. If another party is at fault for our members’ injuries, the claims are processed according to normal benefits. Subrogation then coordinates with lawyers, auto insurance companies and member to ensure that once a settlement is reached, SelectHealth is reimbursed for claims paid.


Worker Compensation
When an injury is determined to be an industrial accident, all claims with related diagnosis will be denied. If the WC carrier denies the claim, we need to obtain a copy of that denial before we can pay claims. After the denial is received, SelectHealth becomes primary and processes claims according to benefits. When a provider receives duplicate payment from both SelectHealth and a workers compensation carrier, they should call SelectHealth and request our payment be taken back.


TPL (Third Party Liability)
This category covers most accidental injuries not listed above. Including, but not limited to, injuries in a public place, injuries which occur in a home, slip & fall injuries, hit by an object, church ball games, etc. These claims are usually paid by SelectHealth. Subrogation researches each case to determine if another party should pay, in which case, SelectHealth would eventually be reimbursed for any claims paid. Some possible payers would be homeowners insurance or property insurance.


Medical Malpractice
If a member feels they received medical care where the outcome was not satisfactory and they feel it was due to negligence on the part of a medical provider or medical facility, they may file a medical malpractice suit against a provider or facility. SelectHealth pays the member’s medical claims according to normal benefits. The Subrogation team works with the member’s attorney or risk management to determine how much money will be reimbursed if the malpractice case is won.

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