Effective Counsel in Injury Litigation Requires a Sound Knowledge of the Law Related to Medical Reimbursement and Subrogation
This morning, the workers' compensation attorney Jon Gelman had an interesting note on his blog about a recent Medicare recovery case filed here in Alabama. Essentially, the case involves the United States seeking to recover medical payments made by Medicare on behalf of several injured individuals.
The case raises an often misunderstood and complicated issue that we must handle on a daily basis. Most often, our clients have some type of health coverage that pays their medical bills. For many, this coverage is provided by private insurance such as Blue Cross. For others, coverage may exist through some type of government program such as Medicare, Medicaid, or the Veterans' Administration. Normally, when we seek medical care our particular coverage provides some level of payment. Typically, this is the end of the story. However, each of these plans or programs possesses unique rights to be reimbursed for their payments if an injured individual then recovers for their injuries from some third party, such as a personal injury lawsuit recovery.
Many personal injury attorneys seem to focus exclusively on the value of their case from the perspective of what amount of verdict or settlement can be obtained from the responsible defendant. Personally, I believe that every case should be prepared for trial, rather than simply a settlement, from the beginning. While this should be the most important focus of an injured person's legal counsel, it should not be the sole focus. Too often, legal counsel ignores the complicated issues of medical reimbursement and subrogation. Each particular type of coverage brings unique recovery rules and rights to the table. These recovery rights are probably the greatest with Medicare. In the case of Medicare, the government has far reaching rights to pursue claims against not only the injured party, but also, their legal counsel and the original personal injury defendant. In the case of Medicare, as opposed to a typical private plan in Alabama, those rights even extend to future medical costs.
Effective legal representation in personal injury cases requires an attorney to understand the complex web of subrogation law and to deal effectively with the specific providers. This is important to avoid a negative action by the coverage provider such as a lawsuit or a future refusal to provide benefits. Also, if counsel clearly understands the various rules and how to use them, he can often work a resolution that minimizes any reimbursement, and thus, maximizes the recovery ultimately provided to the injured individual.
