MAXIMIZING YOUR NET SETTLEMENT
By reducing
Medical Liens
There
are several ways to maximize your
bicycle injury settlement. Let’s talk
about a couple.
A current hot legal issue is whether you
have to repay your health care
insurance company from your settlement
proceeds. The health care
companies assert they have a contractual
right to recovery in their plan. They
want any medical bills they paid
reimbursed. It seems odd the insured
(you) has to repay his insurance
company. After all, you loyally paid
premiums for coverage and would expect
to receive a benefit in exchange for the
premiums you paid. That’s why your paid
premiums in the first place.
Reimbursement is not fair, because this
will reduce your net settlement. A
recent case entitled
Shereboff v. Mid-Atlantic Medical
Services, Inc. (2006) 126
S. Ct. 1869 has discussed this issue and
the interplay between consumer friendly
Federal Erisa legislation that
historically exempted repayment.
The US Supreme Court has held that an
Erisa plan can seek reimbursement from
the insured’s settlement of a lawsuit,
provided it can place a lien on an
“identifiable account”.
More specifically, the lien recovery
companies will argue that if the injury
victim or his lawyer is in possession
and control of settlement funds when the
lien is asserted then there is an asset
to enforce an equitable right of
reimbursement. So, timing and
distribution of your settlement,
as well as a lien reduction,
are factors to consider with your
experienced trial lawyer.
Having an experienced trial attorney can
often help you negotiate a lien
reduction based on the
attorney’s rate of recovery. This
savings (i.e. a 33% reduction) can be
passed on to the injured client.
There’s also another lien reduction
theory, called the “made whole”
doctrine. If the injured party
is not made whole due to low insurance
policy limits by the wrong doer, it can
be argued the victim should not have to
reimburse settlement funds to the health
insurance company. This would be
inequitable. So, a “waiver” of repayment
may be in order. (Should you have a
“medical payment” coverage provision on
your auto policy – these same
negotiation strategies may apply).
A second form of attack on your
settlement can come from a statute
called Civil Code section 3045
et al. This allows a medical
provider like a hospital (as opposed to
a health care insurance company) to
recover up to half of your recovery. I
always argue their recovery begins after
attorney fees and litigation costs are
paid. This protects your settlement
fund. (Where as, uninsured –
underinsured motorist cases can be
totally exempt from repayment, it
depends on the insurance contract.)
In conclusion - learning how to identify
the type of lien asserted and negotiate
around different types of liens requires
an experienced lawyer who has studied
this complex ever changing area of law.
Since 1983 I have watched this area of
law evolve. Knowing the lien laws
nuances’ has helped save clients
thousands of dollars.
I take pride in maximizing your
net settlement recovery by
working out a reasonable settlement
strategy for you and or your loved ones.
Ride safe, ride strong.
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