Many seniors have enrolled with various insurance companies or through AARP into Medicare+Choice programs. These programs pickup and help pay for Medicare Benefits as well as offering additional insurance options. You may ask what does this have to do with Personal Injury cases. Well after a case settles, some sticky issues with healthcare providers are still left to be untangled. Let’s say your trip and fall case settled for $60,000. If a health insurer, i.e. US Healthcare, paid your medical bills of $10,00 then US Healthcare would say you owe them $10,000 of that $60,000. A fter a few deductions which are called procurment costs are deducted, you would owe US Healthcare about $6,500 of your settlement.
Now, you may say that isn’t fair, you paid a lot of money for that healthcare policy. Check the fine print in the policy and you will see a provision saying if you recover money from another insurer then you must repay US Healthcare. New York State thought this was a little unfair, especially because when people settle a case, they rarely get 100% of the value of the injury or get full reimbursement for healthcare expenses. So an excellent law was passed in 2009 called General Obligations Law 5-335. This law essentially nullifies the healthcare insurance company’s ability to collect on the settlement. A Great win for New Yorkers.
One big exception in GOL 5-335 is for “Statutory Reimbursement”. Statutory reimbursement includes thing such as Workers Compensation and Medicare provided by the Federal Government. Medicare+Choice companies argue that they are entitled to reimbursement by the Federal Medicare Statutes the same as the USA. We disagree with this interpretation of the Medicare Statute and are currently fighting Oxford Insurance Company in Court on this issue. We have submitted our motion to extinguish Oxford’s lien and the motion was recently submitted.
Stay Tuned.
Bruce Montague & Partners http://www.montaguelaw.com
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