Recovery of Medical Expenses in Personal Injury Cases

Sometimes entities may seek to recover medical expenses in the course of a personal injury case. The most common are:

• Medicare
• Medicaid
• Health insurance contracts
• Private employer health plans
• Medicare Advantage Policy
• State Insurance Fund
• No-Fault Insurer

With regards to Medicare, Congress has mandated that Medicare seek reimbursement from the injured party for conditional payments made for injury-related medical expenses. There is a provision for hardship exemptions, however. If an injured party receives a settlement but does not repay Medicare, Medicare can bring an action directly against the injured party or the liability insurer for double the amount due. The right to recover is triggered when a case settles or a verdict is issued. Medicare typically provides a final lien payment amount after receiving the final settlement documents. An injured party must pay the Medicare lien within 60 days of receiving Medicare’s final demand letter. Courts may enforce a settlement that does not include a Medicare direct payment provision where a Plaintiff acknowledges responsibility to pay the Medicare lien.

Parties can minimize the impact of a Medicare lien on settlement if they prepare accordingly. In order to increase the possibility of a sound settlement, the matter of liens should be included. Settlement agreements can be fortified by determining the final lien amount and addressing it. Relevant information to provide to an attorney initially to be able to address medical recovery issues includes:

• Arrangements for payment of medical bills,
• The Plaintiff’s Medicare status,
• Whether Medicare has been notified, and
• Provision of medical bills

If you have questions about recovery of medical expenses in a personal injury case, consult with an experienced personal injury attorney to explore your rights and obligations.