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Understanding Health Insurer Liens in Personal Injury Lawsuits

  • February 12, 2024
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When you've suffered personal injuries in a motor vehicle or slip-and-fall accident and you are pursuing a claim for compensation, there is a chance your health insurer might assert a lien on your case and seek to recover any money it paid towards the treatment of your accident-related injuries. It is crucial to understand why and when a health insurer is entitled to get paid from your personal injury case, as many health insurers will assert a lien on your case when they are not entitled to it.

In this blog post, we'll explore what health insurer liens are, how they can impact your personal injury lawsuit, what it means for you as an injured individual, and what the experienced attorneys at Antonucci Law can do to fight back against any health insurer liens.

What is a Health insurer Lien?

A health insurer lien is a legal claim that a health insurer has on the proceeds of a personal injury settlement or judgment. In simpler terms, it is your health insurer’s way of seeking reimbursement for medical expenses it has paid on your behalf. Costs for routine primary care doctor visits or expenses unrelated to your accident are not subject to reimbursement from your accident claim or lawsuit. Your health insurer is only entitled to recover the medical expenses that it pays for your accident-related injuries.

A health insurer’s ability to recover its costs from your case is derived from the Employment Retirement Income Security Act (ERISA). Under this act, your health insurer has a right to recover its costs from your settlement for payment of medical treatment for accident-related injuries. The insurer’s right to recover those costs is dependent on several things, including the insurer’s status and its source of funding for the specific health plan.

How Does it Work?

When you seek medical treatment after an accident, your health insurance policy typically covers a portion of your medical expenses. Whether it is your primary source of coverage in a slip and fall accident or your secondary source of coverage in a motor vehicle accident, your health insurer will likely have made some payments for your treatment. At the conclusion of your case, whether you receive a settlement or a judgment, your health insurer will likely be there to collect its money back from you.

Fighting an Asserted Lien

As mentioned above, not every health insurer has a right to assert a lien. In some instances, your health insurer might be asserting a lien on your case when it is not entitled to it. To be entitled to recover its expenses, a health insurer needs to be Fully Self-Funded. What this means is that the contributions that pay for the plan come entirely from the employees, and the insurance plan is not funded by any outside source.

Only when a plan is truly fully self-funded is it entitled to recover its costs from your personal injury case.

Determining the validity of an asserted lien requires an in-depth analysis of extensive and lengthy documents, including the health insurer’s summary plan description and it’s tax filings, to name a few.  

Why It Matters To You?

Understanding the impact of health insurer liens is crucial in personal injury claims and lawsuits. Here are key considerations for you:

  • If the lien is valid, you will be legally obligated to repay your health insurer.
  • The amount of the lien will reduce the amount of compensation you receive from your personal injury settlement or judgment.
  • The amount of the lien asserted by the health insurer may be negotiable.

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By working with the experienced personal injury attorneys at Antonucci Law, you can rest easy knowing that you won’t be taken advantage of by your health insurer and that your recovery for your personal injuries is maximized.

If you have questions about health insurer liens in your injury case, consult with the experienced and knowledgeable attorneys at Antonucci Law who can guide you through the process and advocate for your best interests.

Note:  See our blog post as to why you should never select your “health insurance primary” on your car insurance policy!)

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