What You Need to Know about Healthcare Obligations in a Personal Injury Claim

Under various Federal and State laws, when a plaintiff receives a personal injury settlement, he or she must use part of that settlement to pay back whoever paid for the medical care needed to treat the injury, whether it's the government, your employee health plan, or your health insurance company. These healthcare "liens" or "reimbursement obligations" are now a part of almost all personal injury settlements.

Yet many plaintiffs are not aware that they may have such obligations when they settle their personal injury case. Courts, defendants, and healthcare providers are placing stronger emphasis on satisfying healthcare liens related to a personal injury settlement. Laws and regulations, and the healthcare coverage policies that interpret them, often place the burden on the plaintiff to verify whether or not a healthcare provider has a lien, and if so, to resolve it. Therefore, as a plaintiff, you should take a few moments to make sure you understand your healthcare benefits, your obligations, and your rights. Proactively evaluating and resolving any healthcare provider's reimbursement interest before your settlement will help provide for your continued access to quality healthcare after settlement.

What is a lien?

We often think that healthcare coverage is meant to pay for all of our medical needs, no matter what the cause. However, the concept behind healthcare liens in personal injury settlements is that the responsible/negligent party should pay the medical bills. Therefore, regardless of your past premiums, co-pays, or deductibles, if a third party (i.e., a "defendant" in a personal injury claim) is liable for your injury, that third party ultimately should pay for your medical bills, not your healthcare plan. Most healthcare plans, whether provided by the government (federal or state programs) or by your employer, create their right to a claim or lien on any settlements when you originally became entitled and accepted coverage. This right of recovery is disclosed within the plan documents, but many individuals are not aware of this or even think about it, because most never foresee themselves as a victim of a personal injury event.

A healthcare plan's lien is typically focused solely on injury-related medical expenses paid for from the date of the injury through the date of settlement.

What can be done to ensure the most favorable result?

As your attorneys, we are dedicated to maximizing any settlement you may receive. However, the rules surrounding healthcare liens concern a different area of the law requiring a different focus. Both private and governmental healthcare liens constitute a complex field with potential impact on future healthcare coverage for you and your family.

As a result of the complexity involved in resolving healthcare liens, our firm has made the decision to engage a specialized company to ensure compliance with your healthcare plan while maximizing your net recovery. The Garretson Firm Resolution Group has many years of experience and dedicated systems, processes, and people to ensure our clients receive the best result possible. We will remain your attorney, but will engage the Garretson Firm Resolution Group as needed in the event you have healthcare liens to resolve. They will work under our direction and will provide information and status updates to our firm as the case progresses through the lien resolution process. Details with regard to any potential fees associated with their work are disclosed in our fee agreement with you.

Don't hesitate to contact Kay Van Wey at (800)489-5082 for a free, no obligation consultation.

Van Wey Law serves:

The entire state of Texas, including Dallas, Plano, Frisco, McKinney, Fort Worth, Austin, Houston, and San Antonio

The entire state of Oklahoma, including Tulsa and Oklahoma City

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