Episode 107: Calloway County injury attorney Jeff Roberts explains how a healthcare lien affects your settlement. This is a situation that may surprise you if you’ve been injured, settled your claim and received your settlement check. If the healthcare lien hasn’t been resolved, it might not be time to celebrate.
What Is a Healthcare Lien?
Jeff explains that if you’ve been involved in an injury resulting from someone’s negligence, such a car wreck or workplace injury, you probably sought medical treatment. If your health insurance paid for any of the treatment, regardless of whether it was private insurance, Medicare or Medicaid, the health insurance carrier has a right to be reimbursed for the expenses it paid on your behalf. This comes into play when you have received a financial settlement. The health insurance carrier will place a lien on your settlement, to ensure they are reimbursed. The lien is sometimes referred to as a subrogation interest.
The negligent person is legally liable for at least a portion (if not all) of your medical bills. Once that claim is settled, the lien will be asserted.
A Healthcare Lien Is Fairly Common
It’s actually not uncommon for a healthcare lien to be involved in a personal injury claim. Jeff comments that he deals with this issue in nearly every car wreck case he handles. For this reason, you want to make sure your attorney has experience dealing with healthcare liens.
Do I Have to Pay the Healthcare Lien if the Accident Wasn’t My Fault?
In Kentucky, you are responsible for paying the lien. Again, your attorney should be aware of any and all liens that would have been placed against your settlement. Medicare or Medicaid might not come after their proceeds until 6 months or more after you’ve settled you case. Healthcare liens affect your injury settlement because you’ll be responsible to pay them.
You need to make sure you reserve enough settlement funds to pay the healthcare lien, if it wasn’t already deducted. Your attorney should walk you through this issue, so it doesn’t cause a problem, later.
Work with an Experienced Injury Attorney
The healthcare insurance carrier has a right to be informed. There are processes for notifying the carrier and specific windows of time during which it should happen. There may also be an opportunity to negotiate the amount of the lien that is ultimately paid to the carrier. These are just a few of the reasons why you should work with an experienced, injury attorney.
Why Would You Use Your Health Insurance if the Accident Wasn’t Your Fault?
In a car wreck case, in Kentucky you generally have PIP coverage (also called no-fault coverage or basic reparations benefits). The vehicle you’re in (regardless of which driver was at-fault) pays the first $10,000 of medical expenses, lost wages, and other specific damages. Hospitals and doctors try to submit the medical bills quickly so they can get paid via the PIP coverage.
Jeff advises clients to reserve the PIP benefits by specifically telling the PIP insurance carrier not to pay any of the bills, until they are authorized by the client. Your personal health insurance can handle the medical bills, initially. It may be possible to negotiate a lower amount for repayment, or to take advantage of the lower rates established between your personal health insurance carrier and the hospital, doctor or other medical provider.
Once that lower amount has been negotiated, Jeff will advise the client to authorize the PIP carrier to pay that lower amount. This process may end up allowing the injured client to keep more of the settlement. Had the PIP carrier automatically paid the hospital or doctor at the beginning, they would have paid the full amount of the medical bill.
Healthcare Liens Should Be Covered in Your Settlement Release
If you and your attorney are able to settle you injury claim, you’ll sign a settlement release. It releases the at-fault party from any further liability. There will be specific language in the document stating that you will now be responsible for paying back any claims related to benefits paid to you or on your behalf. This is clause covers any existing healthcare liens. Again, it releases the at-fault party from additional financial liability for paying for these benefits.
If one or more companies tries to recover from the at-fault party, at this point, they can come after you for the payment and related costs such as attorney fees and other expenses. This is why understanding and managing any healthcare liens is so important.
Medicare and Medicaid assert federal liens. Medicare, in particular, can go after anyone who took possession of the settlement funds. That could include the insurance company, the defense attorney representing the at-fault party, the injured person’s attorney and the injured person. It’s a very serious factor in your case. This is why Jeff is careful to properly handle the healthcare lien(s) with his clients.
The office motto for the Roberts Law Office is, “Providing small town service with big city results.” In Jeff’s opinion, part of that small town service is making sure he takes care of all aspects of his clients’ claims. This includes making sure his clients have supporting documentation, should an issue arise. Sometimes, large companies may not realize the lien payment was negotiated and/or submitted.
Dealing with a Healthcare Lien in a Workers’ Compensation Case
Workers’ comp may have a healthcare lien on your settlement involving a third-party claim. Jeff discussed this in Episode 105 on the topic of construction accidents. This could also occur if you drive or operate a vehicle as part of your normal work activities. If you’re on the job and you get injured as a result of the negligence of another person (not a co-worker), you have a workers’ comp claim and a potential claim against the third party. Workers’ comp is primary on paying your medical bills. If you are successful in settling the third-party claim, workers’ comp is entitled to recovering the cost of the medical expenses it paid, on your behalf.
Jeff recently spoke about this, during his presentation at the Kentucky Justice Association 2-day Auto Summit. Jeff was educating other attorneys from across the state on various issues related to workers’ compensation and automobile accidents.
There are different laws that come into play in situations involving workers’ comp, rather than law governing health insurance, Medicare or Medicaid.
Jeff’s had situations in which the workers’ comp carrier didn’t want to pay for a surgery or other procedure. Jeff and his client decided to use the individual’s health insurance to enable them to begin recovering more quickly. Later, workers’ comp was required to reimburse the health insurance party. The client was reimbursed for any co-pays or deductibles.
Jeff Roberts has over 32 years of experienced handling car wrecks and workers’ compensation claims. He’s dealt with insurance companies from day one.
How Are Attorney Fees Handled in an Injury Claim?
In Episode 56, Jeff explained how contingency fees work in an injury claim. Jeff is only paid if he is successful in the case. He’s paid at the end of the case, once it’s been resolved. The fee is based on a percentage of the settlement/verdict. Workers’ comp claims are also handled on a contingency fee, but there are differences in motor vehicle accidents and workers’ comp claims. He’ll be able to explain this, during your free consultation about your specific situation.
Jeff also advances all of the litigation expenses related to your case. This relates to the costs related to gathering the evidence, presenting your case, expert witness fees, medical records fees, deposition costs, filing fees, etc. Once the case is resolved, those expenses will be paid from the settlement/verdict. If Jeff is unsuccessful in winning your claim, his fees and the litigation expenses are not passed on to the client.
Closing Comments
In Jeff’s experience, every health insurance contract he’s seen in 32 years of practicing injury law has contained clauses related to the carrier’s right to be reimbursed. For workers’ comp, Medicare and Medicaid, they have this right according to state or federal statutes.
You should have your attorney review this issue with you. It’s important to know how any healthcare liens will be handled. The attorney should be proactively engaging in this conversation with you. This also is a good time to discuss why he/she may recommend using your own health insurance, if needed.
Jeff takes significant time to explain these issues, but also welcomes the chance to answer questions. He wants to make sure his clients fully understand how these issues will be handled. Good communication is a key aspect of his relationship with his clients. It’s reflected in the high number of 5-Star Reviews he’s received, over many years.
We hope you found this episode insightful and helpful.
Thank you for listening!
What Do Other Clients Think About Jeff?
We always encourage listeners to read the Google Reviews Jeff Roberts has received from many of his clients. A 5-Star rating and the comments are earned recognition and demonstrate Jeff’s commitment to his clients. As a solo attorney, he has more Google Reviews than some firms with multiple attorneys. Jeff shares the credit with his staff at the Roberts Law Office. Successfully representing injured clients is a team effort. It’s why Jeff likes to say his firm offers small town service with big city results.
Jeff Roberts Represents Injured Clients Throughout Kentucky
With offices located in Calloway County (Murray) and now in Christian County (Hopkinsville), Jeff has a history of representing personal injury clients, workers’ compensation clients and social security disability clients across the state. He’s represented clients from Paducah, Bowling Green, Louisville, Covington, Whitesville and many other Kentucky locations. He’s not just a Western Kentucky injury attorney.
Is It Time to Speak with an Attorney about Your Injury Claim?
The office phone number is (270) 753-0053 or toll free at 800-844-5108. For more information, visit www.JeffRobertsLaw.com. This podcast is meant to provide information and is not legal advice. Jeff’s principal office is located at 509 Main Street, Murray, Kentucky. Co-host Jim Ray is a non-attorney spokesperson. This is an advertisement.
