Keeping those who have injured your employees accountable is important.

Informing your employees how this process benefits them is every bit as important. 

Health Plan subrogation not only saves your company money, it also helps keep premiums low for your plan.  In this way, employees can enjoy increased benefits while also saving their hard-earned money.  But the subrogation process can be misunderstood, and it is not uncommon for plan members to be confused when confronted by their plan obligations.  We often hear the familiar questions:

  • “Why do I owe the health plan money?”
  • “Why are my benefits in suspension?”
  • “Who is this subrogation company calling and writing me?”

An Introduction to Subrogation

“Subrogation” in relation to a health plan may not be an everyday word for many, but it doesn’t have to be scary word for plan members either. Previously we’ve touched on how to avoid a subrogation interest from blindsiding an injured party when settlement time arrives.  Best practices dictate that from the outset, members should clearly understand that in the case of an accident with an at-fault party they will have specific responsibilities.

Health Plan Subrogation – On Your Side

Advanced Health Plan Subrogation is about more than just dollars and cents, and there is no limit to what makes Vengroff Williams, Inc. so advanced.  From acting in the role of employee advocates, VWi takes part in communicating to members various contractual obligations.  This can help set expectations and prepare plan members for their responsibilities when an injury arises and what they may owe in outcome of a settlement or judgment for damages.  Punitive damages, statutory damages (double/tripled), and in tragic cases loss of consortium or funeral costs; these are examples of potential jury awards created to penalize tortfeasors and to award a victim and help make them “whole”.  It is important for a victim to understand that free medical payments is not one such jury award.  Communicating all of this information up-front with plan members eases an already arduous process and provides a baseline of understanding, while ensuring maximum recovery for your company:

  1. Make sure the injured parties understand their rights and responsibilities
  2. Preparing the injured party for the potential of subrogation
  3. Explain in simple words
  4. Answer their questions
  5. Contact involved attorneys/third party tortfeasors and uphold your health plan’s lien interests
  6. And of course, provide copies of the plan and if applicable, proof of self-funded ERISA status in order to ensure all sides are meeting contractual agreements. 

A Benefit to All

Subrogation has been misunderstood for too long and should be recognized as a benefit to all members of the health plan.  It should not be viewed as a threat to a fair settlement for the injured party.  If your members are asking “Why do I owe the health plan money?” or “Why are my benefits suspended?”, this is probably a good time to take a serious look at improving your health plan subrogation process. 

Make Your Health Plan a Winner

You can make your health plan a winner and improve employee satisfaction, reduce plan expenses and see a huge reduction in the number of phone calls and emails you receive from confused plan members.  If you have any questions or would like some additional information, we are always here to help. Call us to day.


Vengroff Williams is an industry-leading Health Plan subrogation provider for Fortune 500 and Global 2000 firms.