Evaluating an offer to settle a bodily injury claim from any kind of accident involves many considerations; a practical one for your bottom line is determining if someone (such as your health plan, your healthcare provider or another) may have a right to recover or be reimbursed from the settlement money being offered. Such recovery, reimbursement or subrogation rights that may be held by another relative to a bodily injury claim matter are generally referred to as lien claims. Some common lien claims that could be encountered for injury claim settlement include:
Medicare/Medicare Advantage Plan
If Medicare or a Medicare Advantage Plan paid medical expenses related to your injury treatment from an accident, you can expect the need to address from the settlement their superior, federal law-based recovery rights arising from their medical expense payments.
Arizona’s Medicaid program is commonly known as AHCCCS. If AHCCCS has paid medical expenses related to your accident-related injury treatment, you can expect the need to address from the settlement its federal law supported, as well as Arizona state law supported, recovery rights from its accident-related medical expense payments.
Hospitals and Healthcare Providers
Hospitals and other healthcare providers in Arizona who have rendered services for accident-related injury treatment have a statutory means of imposing a lien against an injured person’s damages claims from a third-person’s fault. For these liens to be valid and enforceable, healthcare providers must strictly follow specific statutory perfection requirements. If the healthcare provider has unpaid medical charges for its injury treatment services, and it properly perfects its lien, you can expect the need to address in achieving a settlement a resolution of the healthcare provider’s lien claim. In Arizona, this lien claim does not extend to recoveries for injuries under uninsured or underinsured motorist insurance coverage benefits.
When a person is injured by a third party during the course of his or her employment, and the injured person has been paid worker’s compensation benefits as a result of such injury, Arizona law affords the paying worker’s compensation insurer recovery rights for benefits it has paid or may pay in the future. Expect when settling an injury claim against a third person at fault in such circumstances, that the worker’s compensation insurance carrier’s recovery rights will need to be addressed and resolved. In Arizona, such recovery rights extend only to claims against a third party at fault for an injury. They do not extend to benefits an injured person may be entitled to receive under uninsured or underinsured motorist insurance coverage benefits.
Auto Medical Payments Coverage
If your injury claim is from an auto accident, and your own auto insurance has paid under medical payments coverage more than $5,000 for your accident-related medical expenses, then you can expect the need to address from the settlement your auto insurer’s lien claim allowed by Arizona law for medical expense amounts they paid above $5,000.
Private Health Insurance Plans
In the context of lien claims, Arizona is commonly referred to as an anti-subrogation state. What this means in specific connection with medical expense benefits that may have been paid by a privately purchased health insurance plan, is that such a plan will not ordinarily have enforceable rights of recovery or reimbursement from a bodily injury claim settlement with a third party at fault, or involving claims for uninsured or underinsured motorist insurance coverage benefits, for any accident-related medical expenses it may have paid.
Determining, evaluating and resolving valid lien claims relative to bodily injury claim settlements are complex processes in an evolving field of law. This is a brief summary of a few of the lien types and considerations that could be encountered and have to be addressed when considering a potential injury claim settlement. Any one of the lawyers in our firm would welcome your call if you have need of help with an injury case or associated lien determination and resolution questions.
Dan A. Wilson