Subrogation and Your Personal Injury Claim Part Three: Health Insurance, Medicare, and Medicaid
Now that we have established what subrogation is and why it must be paid, lets talk about some of the different entities that have subrogation rights when it comes to your personal injury claim.
Medicare is funded by the Federal U.S. Treasury and Medicaid is funded by a combination of state and federal funds. These two major entities have strict subrogation regulations because they are assistance and retirement programs who benefit many individuals. So, in the event of a first or third party settlement you, the beneficiary, are obligated to repay these benefits. You will only be responsible to pay back benefits associated with accident related treatment. In addition to your obligation, your attorney, and the auto insurance carriers can be held responsible for not doing their due diligence to ensure that all Medicare and Medicaid beneficiary’s claims are reported to the necessary reporting agencies. Therefore, it is crucial that you are honest and tell your attorney that you are a Medicare and Medicaid beneficiary.
Similarly to Medicare and Medicaid, private health insurance carriers usually also have subrogation rights in the event of a third party and first party settlement. Some private health insurance carriers do not have a subrogation clause in their policy and do not have a right to subrogation, but it is important to find out what your specific policy contains, each one is different. In view of the foregoing, regulations for reporting to private health insurance carriers is not as strict as Medicare and Medicaid, but still necessary. It is necessary because if your claim is not reported, and the lien is not paid back from the proceeds of the settlement, you, the beneficiary, could be held directly responsible for reimbursement of that lien.
These are just a few examples of entities that may have a right to subrogation. There are many more such as, Medical Payments Benefits, Workers’ Compensation, short or long term disability, etc. In summary, subrogation is a huge part of most personal injury claims and can sometimes be confusing. It is important that you have a good legal team on your side to help you navigate the subrogation process.