New Jersey Pennsylvania Wrongful Death and Injury Lawyer
Medical Lien and Payment Issues
Call me at 609-277-3166 in NJ or 215-599-6544 in PA
As a Pennsylvania and New Jersey Wrongful Death and Personal Injury Lawyer, a common issue that has to be addressed in the cases I handle is determining who is going to be paying the medical bills as they come due. This issue also includes a related issue as to whether the entity making the medical payments, i.e. Medicare, BC/BC, Medicaid, workers’ compensation carrier, have a legal right to assert a lien over the settlement money to be paid back. These issues are best sorted out by your Wrongful Death and Personal Injury lawyer.
From the offset, most of my clients have concerns about who is going to pay their medical bills and when are they going to be paid. For example, a dog bite victim receives care at an emergency room, and then might need follow-up care with a plastic surgeon or counselor. As a general rule, the victim’s personal health insurance will be responsible for paying the medical bills as they come due. However, as you likely know, many health plans have large deductibles and co-payments. You can incur a $500 or $1,000 co-payment for the emergency room visit, or even the total amount of the bill if you have a high deductible.
Ultimately, the dog’s owner will be responsible for damages including medical bills, wage loss, pain and suffering and disfigurement. However, insurance companies like to settle claims in a single lump sum and not pay medical bills as they are incurred. Fortunately, some insurance policies have Medical Payment provisions, which up to a certain limit (usually from $1,000 to $10,000) will pay medical bills as they come due if the dog bite happened on the insured property. It could be the dog owner’s property or someone else’s. These payments will be made regardless of fault. The simple fact that the dog bite happens on the insured property triggers the Medical Payment coverage. This coverage is offered in policies to help prevent claims. The insurance companies hope that if they pay a victim’s medical bills quickly and without determining fault, the victim may feel satisfied and not pursue a negligence claim for all damages including pain and suffering. Other cases including auto accidents and workers’ compensation claims have different priories in determining who is responsible for paying the medical bills. To protect your rights, you should contact me, a Pennsylvania and New Jersey Wrongful Death and Injury Lawyer, before you ever make important decisions about your or your family member’s claim.
Law on Medical Liens
Like other personal injury claims, an auto accident victim may receive a letter from Medicare or Aetna, or any other insurance company, notifying her that they want out of any settlement to get paid back for the medicals bills they paid. The legal term for this is subrogation. The letter will then go on to ask detailed questions about the claim including the name of your lawyer and the insurance companies involved. At this point, you want to make sure you have a Wrongful Death and Personal Injury Lawyer on your side. Although the letter states they have a right to be paid back, this may not be true under New Jersey or Pennsylvania law if you are dealing with a private insurance company like Aetna or BC/BS. Even if you are contacted by Medicare or Medicaid, there are federal and state laws in place that allow a reduction of the lien amount, and, in some cases, even allow the entire lien amount to be withdrawn if it would pose a financial hardship to the victim.
As a general rule, New Jersey Law does not allow medical bills paid by a health insurance company to be collected in the negligence liability claim. Pennsylvania law does not allow it either in certain cases only such as an auto accident. And because they cannot be collected in the negligence case, the health insurance company then has no right to assert subrogation (a lien) over the settlement for medical bills it paid.
For example, New Jersey Statute 2A:15-97 states: “In any civil action brought for personal injury or death, …, if a plaintiff receives or is entitled to receive benefits for the injuries allegedly incurred from any other source (meaning a health insurance company) other than a joint tortfeasor, the benefits, other than workers’ compensation benefits or the proceeds from a life insurance policy, shall be disclosed to the court and the amount thereof which duplicates any benefit contained in the award shall be deducted from any award recovered by the plaintiff, less any premium paid to an insurer directly by the plaintiff or by any member of the plaintiff’s family on behalf of the plaintiff for the policy period during which the benefits are payable…”
Like many things, there are exceptions to New Jersey and Pennsylvania anti-subrogation laws. For example, if a health plan is self-funded and governed by federal law, it may be entitled to assert a lien over a victim’s settlement money.
If you or a family member have any questions about these complex Medical Lien issues, call me, Joseph Monaco, 2nd Generation Trial Lawyer, for a free consultation. You may call me Toll-Free at 1-855-Joe Legal.