6 Things You Need to Know About Health Insurance Liens
6 Things Everyone Needs to Know to Reduce Florida Health Insurance Liens
Health insurance liens are applied to settlement proceeds when your health insurance pays for necessary treatment due to a personal injury and you receive a settlement. It is almost always better for the injured plaintiff to allow their health insurance to pay for treatment related to the accident. Learn why you should allow your health insurance to cover your car accident.
Most health insurance plans have language in their policy that entitles them to claim a health insurance lien. If the lien is on your health insurance policy, you would have accepted the reimbursement when you signed the policy. Most people are unaware of the legal effects of policy language. They only become aware of the health insurance lien after an injury. If you’re dealing with a health insurance lien, there are a few things you need to know.
Reading: What is a health insurance lien
What laws apply to your insurance lien?
The first thing to determine is which law applies. Health insurance policies written in Florida are governed by the terms of the plan and Florida statutes.
Six things to know when you are injured due to the negligence of others and end up with a Florida health insurance lien:
1. read your health insurance policy to determine if there is a health insurance lien
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First, your health insurance policy is a contract. contracts are based on the terms of the agreement; It is not safe to assume that your health insurance company has a health insurance lien. We have seen insurance companies claim to have a lien on health insurance even when the health insurance policy does not provide such a lien.
Read your policy or share it with your attorney to confirm that the policy authorizes a health insurance lien. The policy language will describe exactly what health insurance lien, if any, your health insurance has on the settlement proceeds. Please note that some policies only apply to third party settlements and not to uninsured or underinsured motorist settlements.
2. your health insurance company can only recover payments for medical care related to your claim
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Your health insurance company has the right to recover payment for medical care; keep in mind that they only have a lien for payments related to your injuries. Your attorney should confirm that the lien is only for bills related to your injury claim.
The first step to confirming this is to request an itemized lien from the insurance company listing all the payments they seek to recover. Your attorney must notify the insurance company immediately if any of the payments listed are not related to your claim.
3. health insurance companies must take into account attorneys’ fees and costs when determining health insurance liens
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Most personal injury attorneys work on a contingency fee basis. This means that your payment is dependent on your client obtaining a monetary settlement. in these cases, the attorneys’ fees are a percentage of the client’s recovery. In addition to fees, the client must reimburse the attorney for expenses incurred during the case.
Florida Statute 768.76(4) limits a lienholder’s right of reimbursement to the actual amount of collateral sources recovered by a claimant from an injurer, less its prorated share of costs and attorneys’ fees incurred by the claimant to recover said collateral sources from the cause of the damage. wronged.
4. Liability and amount of insurance coverage matter in health insurance liens
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Fourth, when more than one person is at fault for an accident, a jury must assign each party a percentage of fault. this is called comparative negligence. in these cases, the insured person is sometimes considered partially at fault and their damages are reduced. The health insurance company in these situations must reduce its lien to account for the fact that the injured party does not receive 100% compensation. meaning that if the opposing party is assigned 50% of the fault, the lienholder should also not receive more than 50% of his or her lien.
Similarly, when a recovery is limited by the amount of insurance available, health insurance companies must take into account what the full value of the claim would have been if there had been a full recovery and adjust their recovery efforts. collection accordingly.
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florida statute 768.76(5) requires the court to “consider any compensation in the amount of the settlement or judgment for any comparative negligence of the claimant, limitations on the amount of liability insurance coverage available to the tortfeasor , or any other mitigating factors the court deems equitable and appropriate under the circumstances.”
5. the lien cannot increase after the date of the settlement or judgment
florida statute 768.76(8) specifically prohibits a provider from claiming a right of subrogation or reimbursement for payments from collateral sources made after the date of waiver, settlement or judgment.
6. the health insurance company must respond within 30 days to a certified mail notice of the claimant’s intent to claim damages or the lien is waived
The process established by Florida Statute 768.76 is very specific, so rather than summarize it, the relevant portions are below.
(6) A claimant shall send to the provider of any collateral source, by certified or registered mail, a notice of the claimant’s intent to seek damages from the injurer. if the claimant has filed a claim against the injurer at the time such notice is sent, a copy of the claim against the injurer must be submitted with such notice. such notice must include a statement that the provider of the collateral sources will waive any right of subrogation or reimbursement unless it provides the claimant or the claimant’s attorney with a statement affirming the payment of benefits and the right of subrogation or reimbursement within 30 days after receipt of the claimant’s notification to the collateral source provider.
(7) Within 30 days of receipt of the claimant’s notice of intent to seek damages from the injurer, the collateral source provider must provide the claimant or the claimant’s attorney with a statement affirming your payment of benefits from collateral sources and the right of subrogation or reimbursement. The Collateral Source Provider’s failure to provide such a statement to the Claimant or Claimant’s attorney within the 30-day period will result in a waiver of any claim for subrogation or reimbursement by the Provider with respect to such Collateral Sources. No right of subrogation or reimbursement shall exist for a collateral source provider that has waived its right of subrogation or reimbursement under this subsection.
Resolving health insurance liens can be complicated. each case has its own facts, and often the parties disagree on which law should apply. Health insurance companies sometimes claim that their policies are governed by another state’s law or even federal law. don’t pay more than your policy or the law of your claim requires.
Call dismuke law, pllc at (863) 292-6922″>(863) 292-6922 or contact us online now if you need legal help resolving your health insurance lien.
source: § 768.76, fl. statistics (2019).