What Is Subrogation? How Does It Apply to Me?

Were you injured in a car accident? Did a dog bite your child? Were you injured on another person’s property? If so, Dean Health Plan (DHP) may have a right of subrogation. Subrogation permits an insurance carrier to recoup claim payments made for injuries or illnesses caused by another party. Your Member Certificate contains a subrogation provision. This means that when DHP pays medical bills for an injury or illness caused by another party, we will seek reimbursement of those medical bills from the other party, their insurance company and/or your insurance company. Subrogation helps us manage health plan costs by ensuring claims are paid by the responsible party.

In order for DHP to determine whether another individual or entity is responsible for your injury or illness, we may send you a one-page injury questionnaire. Please complete and return the questionnaire to DHP within 10 days of receipt. Even if you cannot answer all the questions or if your claim is not accident-related or the fault of another party, it is important for you to return the questionnaire in the envelope provided. You can also fax the questionnaire to us at 608-827-4098 or call us with the information at 608-827-4127 or 608-827-4136. If we do not receive the requested information, your claims may be closed without payment.

If you are injured on the job, your Member Certificate excludes payment of claims for work-related injuries or illnesses. If your claim is denied by the workers’ compensation carrier, please send us a copy of the denial so that we can reconsider your claim. We may also need to know if you plan to appeal the denial.

We thank you for your cooperation with the subrogation process. If you have any questions, we are happy to help! Please feel free to call us at the phone numbers above.

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