Effective Use of the Make Whole Defense for a San Diego Injury Case

Because any amount of reimbursement that a personal injury victim must pay at the conclusion of his or her personal injury case has a major impact on his or her net recovery, it is vitally important for his personal injury lawyer to make effective use of the make whole doctrine. Therefore, an injured client's entire health plan document(s) should be obtained early in the case. (I always ask for this information when I retain my injured clients so I have it early enough to set a good foundation that will eventual help increase the clients net recovery).

Despite the fact that the
make whole rule  has always been subject to waiver, it appears that the majority of insurance and ERISA health plans (and California medical payment - MP provisions) have not yet incorporated an effective waiver.  Early understanding of the health plan provision in question will assist the attorney in presenting defenses more effectively and keeping the health plan's name off of any settlement checks from the at-fault party's insurance carrier.  San Diego personal injury attorneys should be carefully reviewing the contractual requirements of the policy so as not to breach any enforceable provisions therein while raising the defense of the make whole doctrine.  Where an insurance carrier is asserting reimbursement without regard to the make whole rule when its policy does not contain a clear wavier of the rule, a Consumer Legal Remedies Act demand under California Civil Code Section 1750 can be very effective in obtaining a formal waiver under the Act's "safe harbor" provision.