- April 7, 2017
- by Ben Adams
One of the questions frequently asked to the Santa Rosa CA personal injury attorneys at Adams Fietz is ‘what is this lien’? This is because, in nearly every case, the settlement of a serious physical injury claim requires the resolution of one or more healthcare liens. A lien means that a portion of a plaintiff’s settlement may be owed to their health insurer. These health insurers can be private providers or a government provider such as Medicare, Medicaid, or the Veterans’ Administration.
Healthcare liens are often asserted by the following entities:
• Medicare Parts A and B. If Medicare has paid for any treatments related to an injury covered by the settlement, federal law gives Medicare the first right to recover some or all of the payments. Additional payers, if any, must wait until Medicare’s interests are satisfied.
• State Medicaid. California has Medicaid with its own regulations. Medicaid’s right of recovery is similar (but secondary) to that of Medicare.
• Military or other Governmental Healthcare. If a Plaintiff has healthcare coverage through the U.S. Department of Veterans Affairs (VA), TRICARE, Indian Health Service (IHS), or another government agency, and if that entity has made healthcare payments on his behalf as a result of the litigation-related injury, then the Government agency may be entitled to recovery.
• Private Insurers. A private healthcare insurer may be entitled to recovery in the same manner as a government payer, but the insurer’s right of recovery depends on the plan’s contract language and the laws of the state in which it operates, or in some cases federal law. This may also include Medicare Part C.
• Other Insurers. If a client receives medical benefits through any other type of health plan, they may have a legal interest in the settlement.
Depending on the settlement terms, as well as applicable state and Federal laws, the Sonoma County personal injury attorneys at Adams Fietz may have an obligation to provide certain information to providers. The personal injury lawyers may also need to facilitate payment of a portion of settlement proceeds to primary payers.
It is common for the Sonoma County personal injury attorneys at Adams Fietz to hire lien resolution experts who specialize in determining what obligations each party bears in notifying and paying providers. These services help personal injury attorneys to ensure they are meeting our professional obligation to you, and keeping you in good standing with your healthcare provider. It is crucial that the personal injury lawyers properly identify and resolve any obligations to your healthcare provider that are part of settlement. Failure to resolve a lien can result in the revocation of your eligibility for healthcare coverage.