Can the Insurance Company Reduce My Settlement Because I Have Health Insurance Under CT's § 52-225a?

Описание: Can the Insurance Company Reduce My Settlement Because I Have Health Insurance Under Connecticut's § 52-225a? by Dan Petroskey

If you got hurt in a car accident, slip-and-fall, premises liability incident, or dog bite in Waterbury or New Haven County, you may wonder how health insurance affects your personal injury settlement. Connecticut General Statutes § 52-225a and Connecticut General Statutes § 52-225b shape how courts treat collateral source payments like health insurance and auto med-pay. These rules can change the economic damages portion of a jury verdict and can also influence settlement negotiations with an insurance adjuster.

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Connecticut’s collateral source reduction statute applies after a jury decides liability and damages, but before the judge enters final judgment. At trial in Waterbury Superior Court on Grand Street, the jury can see the full medical expenses and other economic damages such as lost wages. After the verdict, the defendant can request a collateral source hearing. The judge then reviews evidence of collateral source payments and calculates a net reduction that applies only to economic damages, not non-economic damages like pain and suffering.

The calculation follows a practical sequence. First, the court identifies what the collateral sources actually paid, using records such as explanation of benefits forms, payment records, negotiated rates, and billed charges. Then the court subtracts insurance premiums paid to obtain that coverage. Connecticut recognizes premiums paid by you, your spouse, immediate family members, and even employer-paid premiums in many situations. The Connecticut Supreme Court addressed this issue in Alvarado v. Black, explaining how employer-paid premiums can count as payments made on behalf of an employee.

A key exception can remove the reduction entirely. Connecticut General Statutes § 52-225a(a) states that the court does not reduce damages for any collateral source that has a right of subrogation or a right of reimbursement. Many plans, including some self-funded ERISA plans, Medicare, and Medicaid, may assert reimbursement rights. When a valid right exists, Marciano v. Jimenez, 324 Conn. 70 (2016) reinforces that no collateral source reduction applies for that source, though the insurer may still assert a lien separately.

These rules interact with comparative fault under Connecticut General Statutes § 52-572h. If the trier of fact assigns a percentage of fault to you, the court reduces your award by that percentage, and the collateral source reduction cannot exceed the remaining economic damages. This detail matters when you evaluate settlement offers and decide how to move forward with a claim tied to treatment at Saint Mary’s Hospital or Waterbury Hospital.

Dan Petroskey, Esq., a Waterbury personal injury attorney at DeFronzo & Petroskey, P.C., helps clients document premiums, review subrogation language, and prepare for a collateral source hearing when a case proceeds to trial. The firm’s office at 255 Bank Street in Waterbury offers consultations at (203) 756-7408, and the team works on a contingency fee basis so you pay nothing unless compensation is recovered.

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