If you have Medicare, or even if you are eligible for Medicare, obtaining a personal inury settlement from an insurance company for a car or truck accident is a very difficult process that will almost certainly require the assistance of an attorney who is experienced in dealing with Medicare and Medicare’s intermediary, MSPRC (the Medicare Secondary Payor Recovery Contractor).  While this has been true for years, recent changes in Federal law have caused insurance companies to take a hard-line stance in dealing with anyone eligible for Medicare when they make a personal injury insurance claim.

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There is no shortcut in making an auto accident insurance settlement when you have Medicare, regardless of the severity of your injuries. Mistakes in handling Medicare lien issues can cause a poor result, delay any settlement for several months, and create problems after settlement.

Dealing with Medicare and their intermediary, MSPRC, is extraordinarily difficult and time consuming.  This article provides some basic advice and information about the payment of accident related medical bills expenses and Medicare’s right of repayment.

When you are injured in a car or truck accident, the “no-fault” coverage on your vehicle (or the vehicle you were riding in if you were not the owner) is considered “primary.” In other words, this insurance—typically called Personal Injury Protection (“PIP”) or Med Pay—should be used before any other insurance to pay your medical bills.

Why should your insurance pay anything if you were not at fault?  The answer is that the at-fault driver’s insurance company will not pay any medical bills until you make a settlement and sign a full and final legal release.  PIP is in place to cover medical expenses in the meantime.  Making a PIP claim should not cause your insurance rates to go up or cause a cancellation of your policy.

But your no-fault car insurance coverage is often a very limited (typically $2,500 in Maryland; often less or zero in Virginia; and usually more in Delaware).  So any medical bills above the amount of your no-fault coverages need to be billed to your health insurance, which may be Medicare.

When we negotiate a settlement for a client and recover accident-related medical expenses, there is almost always an obligation to reimburse the health insurance carrier for the medical bills they paid.  This is called the health insurance “lien.”  If you do not take care of this lien, your health insurance company could later sue you or retract the payments they made to the doctors, which would leave you with unpaid medical bills, or could sue you directly.  Click here for information on liens with health insurance carriers other than Medicare.

The Medicare lien is often referred to as a “super lien.”  Medicare has the right under federal law to sue you if this is not handled properly.  But unlike most other health insurance carriers, Medicare can also sue the car insurance company, even many years later.  This law was made even stricter with the passage of the Federal Medicare, Medicaid, and SCHIP Extension Act of 2007.

As a result, almost all insurance adjusters will refuse to make a settlement for a personal injury claim until you navigate the Medicare Secondary Payor gauntlet.  This is a very difficult and time consuming process, even for most attorneys.  There are several procedural steps, and not all of them are with MSPRC.  The average hold time to speak to a live person at MSPRC is more than an hour.  Once you do talk to a live person, they are not helpful, and usually do not follow through on what they promise will be done.  They always state that any action will take at least 60 days, but often 60 days come and go with no action.

At Robertson & Robertson, P.A., we are very experienced in dealing with MSPRC regarding Medicare’s right of recovery.  While this is still a time consuming process, you can be assured that we know how to cut through the red tape, dispute the frequent errors made in Medicare’s repayment demand, and minimize amount of the final repayment to Medicare.

There is some good news in all of this:  Medicare will reduce its lien to share in the costs of hiring an attorney, as well as any costs in the case (they are required to do so by federal statute).  Oddly, Medicare will not calculate their final lien amount until AFTER a settlement of the personal injury insurance claim.  We know how to obtain up-to-date lien information on a real-time basis so that the final Medicare lien can be predicted as accurately as possible when negotiating a settlement.

I recommend calling us today for a free initial consultation if you have received a letter from Medicare, MSPRC, or a car insurance company regarding the repayment to Medicare of conditional medical expense payments.  I recommend doing so before filling out any paperwork.

Keep in mind that we are most often able to resolve claims without a lawsuit, because we know how to coordinate insurance coverages, properly present the information to the insurance companies to ensure a full and fair evaluation, and to coordinate the settlement to minimize the amounts you have to pay for insurance liens and medical bills from your settlement.

Improper handling of a car insurance injury claim only INCREASES the chances that a lawsuit will be necessary later.  Getting us involved early ensures that your case will be handled properly and vastly increases the chances that you will receive a fair settlement for your case. It also allows us to get started on the Medicare lien process early, so that settlement will not be dragged out for several additional months at the end of your case. Getting us involved also relieves you of the tremendous burden and stress of dealing with insurance adjusters and a load of paperwork, and allows you to focus on what matters most—your medical recovery.

We know how to deal with Medicare, MSPRC, and the insurance companies on these and a multitude of other issues that arise in auto accident claims.  Our friendly and helpful attorneys and staff are standing by to help you. 

Feel free to call us today at 410-749-9111.