Welcome to Law-Forums.org!   

Advertisments:




Sponsor Links:

Discount Legal Forms
Discounted Legal Texts


Hmo Lien Against Settlement

Discussions relating to Personal Injury Law

Hmo Lien Against Settlement

Postby Brocleigh » Fri Nov 11, 2016 8:10 am

In September of 2009, I was struck by a car while riding my bicycle in Washington, DC. I am representing myself.  Recently, the auto insurance company of the at-fault driver agreed on a settlement amount that totaled several times the amount of the medical expenses for the sustained injuries not including lost wages.  I haven't yet signed the release.

I plan to contact my HMO, which provided a large portion of my medical treatments, about the settlement and to negotiate the lien amount I would pay to my HMO for the medical treatments related to the accident. Here are my questions:

1. Can my HMO sue the auto insurance company for their medical costs if I never signed anything giving my HMO permission to try to recover anything from the auto insurance company directly, i.e. "assigning" amounts due to my HMO(even after I repay the HMO a mutually agreeable amount)? 2. I don’t want to do anything to slow down or jeopardize my receiving the settlement check. So, is there any good reason why I should contact my HMO before signing the release?  (I doubt that I can negotiate a higher settlement amount with the auto insurance company than I already have.)

3. So how should I proceed with my HMO?

Thanks in advance for your help!

ANSWER: Don't know DC law but fairly certain it is generally the same everywhere.  
Brocleigh
 
Posts: 45
Joined: Tue Mar 04, 2014 4:04 am

Hmo Lien Against Settlement

Postby Dinsmore » Sat Nov 12, 2016 1:02 pm

That's refreshing. Someone actually reading the fine print and wondering about it. lol.  Anyhow, this is some standard language in your jurisdiction that says in effect that if the other driver or the insurance company do have claims against them by your HMO or anyone else, yes, you will be on the hook.  But as you say and I have said, the HMO has no such legal right; your HMO has no contractual rights against a third party insurance company or driver. Here is where you being there and I being here creates a blank space.I don't know if there is something in the DC law(for that matter is there such a thing as "DC law" or do you follow Federal rules, I don't even know that).  I presume there is not so there is no way that I can imagine that the HMO could proceed against the other parties and therefore, I think there is no reason to be concerned about that paragraph, particularly if you will be settling out with the HMO.  If you are doing that there is absolutely no concern.  There is a situation where this would be of concern:  If the injured party receives medical care thru Medicare, the insurance company has a legal duty to make sure Medicare is reimbursed.  If they fail in that and the injured party doesn't satisfy the Medicare lien, then Medicare might go after the company.  That doesn't apply here of course.
Dinsmore
 
Posts: 45
Joined: Wed Jan 22, 2014 4:58 pm

Hmo Lien Against Settlement

Postby reinhard98 » Sat Nov 12, 2016 5:07 pm

In September of 2009, I was struck by a car while riding my bicycle in Washington, DC. I am representing myself.  Recently, the auto insurance company of the at-fault driver agreed on a settlement amount that totaled several times the amount of the medical expenses for the sustained injuries not including lost wages.  I haven't yet signed the release.

I plan to contact my HMO, which provided a large portion of my medical treatments, about the settlement and to negotiate the lien amount I would pay to my HMO for the medical treatments related to the accident. Here are my questions:

1. Can my HMO sue the auto insurance company for their medical costs if I never signed anything giving my HMO permission to try to recover anything from the auto insurance company directly, i.e. "assigning" amounts due to my HMO(even after I repay the HMO a mutually agreeable amount)? 2. I don’t want to do anything to slow down or jeopardize my receiving the settlement check. So, is there any good reason why I should contact my HMO before signing the release?  (I doubt that I can negotiate a higher settlement amount with the auto insurance company than I already have.)

3. So how should I proceed with my HMO?

Thanks in advance for your help!

ANSWER: Don't know DC law but fairly certain it is generally the same everywhere.  
reinhard98
 
Posts: 51
Joined: Wed May 22, 2013 2:08 pm

Hmo Lien Against Settlement

Postby Caoimhin » Sat Nov 12, 2016 11:26 pm

to #1 is a big NO.  The HMO has no legal rights against the responsible party.  Reason to contact the HMO now would be to see how much they would accept.  It might be more or less than you expect and that might have some impact on the decision you make about settling with the insurance company. You also lose bargaining power with the HMO if you already settled. Prior to settlement you can tell HMO that you are considering an offer of settlement that you think is too low and you may choose to hire a lawyer. They want their reimbursement sooner than later also so at that point you bargain and make them a lowball offer. They might go for it.  If you have a lawyer they automatically reduce their reimbursement demand by the amount of the legal fee....typcially 1/3.....right off the top.  I would contact them and say you could settle now and pay the lien off if they are willing to accept a negotiated amount.  Suggest an offer to HMO of say 50% after deduction of 1/3 or 50% of 2/3 of the gross amount.  Make sure to look at the amount actually paid by the HMO and not just the gross billiing of the medical facilities. Might be a big difference.  The doc my bill $200 for something but the HMO actually paid $50 for it.  You work on the "contract"($50) amount. You have nothing to lose by taking this approach.

---------- FOLLOW-UP ----------

Thank you, Mr. Dorfman, for your quick and thorough response.  That sounds like an excellent strategy.  

I have another question regarding the settlement release of the at-fault auto insurance company.  The paragraph I have concerns about is as follows:

“IN FURTHER CONSIDERATION of said payment, Releasor agrees to defend, protect, indemnify and hold harmless Releasee from any and every claim or demand, loss and expense of every kind, which may ever be asserted by him/her, on his/her account, or by anyone else, arising out of any bodily injuries sustained by Releasor as set forth above, and Releasee shall be entitled to plead this obligation and this Release in defense of any such claim.  Releasor specifically undertakes and agrees to defend, indemnify and hold harmless Releasee for any claims, demands, liens, or assignments, relating to the medical care, diagnosis, or treatment of Releasor, and any workers compensation claims, demands or liens now pending, or which may be asserted in the future, and any liens arising out of the legal representation of Releasor.”

Could any of the words "defend," "protect" or “indemnify” in this release put me on the hook for paying the at-fault driver’s or the auto insurance company’s legal fees or other costs if they are sued?  I realize this may be a moot point if my HMO can’t go after the insurance company anyway, but it’s nice to know what I am signing.

Thanks again!
Caoimhin
 
Posts: 53
Joined: Fri Mar 14, 2014 9:00 pm


Return to Personal Injury Law

 


  • Related topics
    Replies
    Views
    Last post
cron