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Why Did I Receive a Letter from Equian?

Anderson Franco Law Team

If you were involved in an accident, you might have received a letter from Equian. You may wonder who Equian is and why they are sending you a letter. Here we explain some of the common questions we receive regarding Equian.

Who is Equian?

Equian is a health care provider and a healthcare benefits manager. One of their branches of business includes third party subrogation. Third party subrogation is the business of recovering money on behalf of someone. In plain English, Equian is hired to obtain money for their client.

Typically, a healthcare insurance provider hires Equian. Equian then is responsible for investigating healthcare claims to determine whether the healthcare provider should be reimbursed. For example, lets assume you have Kaiser Permanente as your healthcare insurance provider. If you are in an accident and seek medical treatment at Kaiser, then Kaiser will hire Equian. Equian will then investigate your accident to determine whether they can recover money on Kaiser’s behalf.

When is Equian Involved Personal Injury Claim?

Equian becomes involved in a personal injury claim after a health insurance notifies Equian. Typically, if a medical insurance provider suspects that an accident was caused by another person, then they can forward the information to a company like Equian.

Equian then investigates whether they can recover money for their client. This includes determining who caused the accident and whether that person has insurance. If a third party could be liable, then Equian often seeks reimbursement of medical bills.

Why is Equian Entitled to Money?

Equian is entitled to recover money on behalf of their client. This is because they act on behalf of their health insurance clients, who are entitled to recover money. But why are they entitled to money from an injury claim?

Healthcare insurance providers are entitled to recover money when they incur expenses due to someone’s negligence. If you are injured in an accident, then you likely will seek treatment through your healthcare insurance provider. While you may pay a copay for the services, your health insurance pays for the rest of the actual cost of services. So while you may have lost money for paying copay services, your health insurance also had to pay money because of the accident. So whoever caused your accident is not only responsible for reimbursing your copay, but also reimbursing the health insurance costs.

Do I Have To Pay Equian?

If Equian has a right to reimbursement, then you generally have to pay Equian. Typically, the health insurance company’s right to seek reimbursement is explained in your health insurance coverage plan. When you agree to become a member of your health insurance plan, such as Kaiser or Blue Shield, you agree to the membership terms – these terms typically explain these subrogation principles.

Most often, these terms state that the insurance carrier is entitled to recover for the costs they incurred. Typically, they can seek the costs directly from the third party that injured you. Alternatively, they can seek reimbursement from you. In these instances, even if you settle a personal injury claim with the at-fault third party, you can then be held responsible for paying some of the settlement money to Equian.

Keep in mind that Equian’s right to reimbursement also depends on other factors, including whether it was a work injury, whether the settlement proceeds are from UIM policies, ad/or the total amount of settlement money that is available.

Should I Consult with A Lawyer if I Receive A Letter from Equian?

If you receive a letter from Equian, then it means it is possible that you could be entitled to compensation. Equian will only seek reimbursement for their own clients, which typically are the healthcare insurance provider. Equian will not seek money on your behalf. This means, you should consider whether you could recover money also. As such, you should discuss your situation with a lawyer who is familiar with Equian and handling personal injury claims.

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