Personal Injury Lawyer

One of the most frustrating aspects of personal injury cases for injured clients is when their health insurance claims a right of subrogation (also known as a lien or right of reimbursement) over their settlement proceeds. In this blog, we will discuss some situations where you may or will be required to reimburse your health insurance out of settlement proceeds and how an attorney can help you to maximize your recovery and minimize reimbursement amounts.

Medicare and Medicare Advantage Plans

If your health insurance is through Medicare and/or a Medicare Advantage Plan, then there are federal laws that require you to reimburse them out of your settlement proceeds. These federal laws state that Medicare has a first right of reimbursement over and above anyone else. One important aspect of Medicare’s right of reimbursement is that it is required to provide you with a discount on what you owe based on your procurement costs (any attorney’s fees owed and costs advanced), so you ultimately should not have to reimburse Medicare in full. There are also certain unique circumstances where you can seek a waiver of Medicare’s rights.

Medicaid

If your health insurance is through Medicaid, then subrogation rights will vary based on state law. Most commonly, there will be requirements to reimburse Medicaid out of your settlement proceeds, but there are often avenues for an attorney to get this reduced depending on the facts of your case. There are also sometimes caps or limits on how much of your settlement Medicaid will be entitled to depending on the specific facts. It is important to have an attorney representing you to make sure you are not overpaying Medicaid.

Private health insurance policies

There are many other health insurance carriers and different types of coverage which may or may not be entitled to reimbursement out of your settlement proceeds. Again, state laws will vary on these policies. Some states have anti-subrogation statutes that set the general rule that private health insurance carriers are not allowed to get reimbursed out of settlement proceeds. Even if that is the case, there is a federal statute known as ERISA that can allow certain self-funded health insurance policies you receive from your employment to claim reimbursement out of personal injury proceeds. These are complicated questions that an attorney needs to review to answer in your specific case after reviewing your health insurance plan documents.

This blog post is not intended to cover every situation which allows your health insurance subrogation rights over personal injury settlement proceeds. These are very fact specific situations which our personal injury lawyers at Garrett, Walker, Aycoth & Olson, Attorneys at Law can help explain about your particular case. It is important to have an attorney help you with your injury case to make sure that you are not reimbursing your health insurance more than it is entitled to receive. Give us a call today!