On October 2, 2019, a World War II-era B-17 flying fortress bomber departed Bradley International Airport in Connecticut for a local sightseeing flight with 10 paying tourists on board. Shortly after takeoff  the pilot radioed that he was returning to the airport because of an engine problem.  A witness reported
Once youâve already identified someone as a Medicare beneficiary (or someone with the reasonable expectation of becoming one within thirty months), the easiest way to make sure youâre compliant is to follow the acronym âCAD.â
KPIX5 asks Mike Danko about the criminal charges brought against PG&E for its role in the Kincade fire. Danko explains that even if a jury renders a guilty verdict, no one at PG&E will go to jail. Itâs the civil justice system, not the criminal justice system, that compensates victims
Heidi Ahlborn was injured in a very serious car accident in January of 1996. At the time, she was a nineteen-year-old college student pursuing a degree in teaching. She suffered a catastrophic brain injury that left her incapable of finishing college and unable to care for or support herself in the future. When the Arkansas Department of Health tried to assert a lien against Ahlbornâs settlement, she sued, and the case went all the way to the Supreme Court, who found in her favor.
As of April 1, 2011, a Responsible Reporting Entities/insurers (RRE), (liability insurer, self-insurer, no-fault insurer, and workersâ compensation carriers) must determine whether a claimant is a Medicare beneficiary (âentitledâ) and if so, provide certain information to the secretary of Health and Human Services (hereinafter âsecretaryâ) when the claim is resolved. This is the so-called Mandatory Insurer Requirement, MIR for short.
Consider this scenario: you represent a current Medicare beneficiary in a third-party liability case. As part of the workup of the case, you determine the client will need future medical care related to the injuries suffered, and you settle the case. Since the client is a Medicare beneficiary, the defendant will report the settlement under the Mandatory Insurer Reporting law as it is greater than $750 in gross settlement proceeds.
For many years, personal injury cases have been resolved without consideration of Medicareâs secondary payer status even though since 1980 all forms of liability insurance have been primary to Medicare. At settlement, by judgment or through an award, an injury victim would receive damages for future medical expenses that were Medicare-covered. However, none of those settlement dollars would be used to pay for future Medicare-covered health needs. Instead, the burden would be shifted from the primary payer (liability insurer or workersâ compensation carrier) to Medicare. Injury victims would routinely provide their Medicare card to providers for injury-related care.
What do you do when you settle a case like this where your client is on public assistance, there are allocation issues, settlement planning issues must be addressed, and there are liens to negotiate? Where can you âparkâ the money while you set up any necessary public benefit preservation trusts, determine allocation of the proceeds, figure out a financial plan, and negotiate the liens?
Most, if not all, ERISA health insurance plans state that injuries caused by a liable third party are not a covered expense and require reimbursement when a plan pays for injury-related medical expenses (often referred to as subrogation clauses). ERISA provides that health plans which qualify under its provisions can bring a civil action under section 502(a)(3) to obtain equitable relief to enforce the terms of the plan. Appropriate equitable relief is really the only enforcement mechanism an ERISA plan can utilize to address its reimbursement rights contained in the plan.
The Medicare programâand the related Social Security Disability Income/Retirement benefit (SSDI)âis one of the primary benefit programs available to those who are injured and disabled. Understanding the basics of this program is imperative to protecting the clientâs eligibility for their benefits.
Medicare and SSDI benefits are an entitlement and are not income or asset sensitive. Clients who meet Social Securityâs definition of disability and have paid enough quarters into the system can receive disability benefits regardless of their financial situation.
John Doe was a laborer since age eighteen, but when he was thirty, he was severely injured and became paralyzed. John didnât have health insurance at the time of his accident, and the hospital applied for Medicaid on his behalf after getting injured. He qualified for Medicaid, since he had no real assets and no longer had an income. His family applied for Social Security Disability since he had worked enough quarters to be insured. Johnâs personal injury lawyer has settled the case for $1,000,000, which will help him pay for everything he now needs, but it is far less than what is needed to pay for all his future medical care. The question now is what to do with the settlement?
Mrs. Smith was moved to the ICU and no neurologic monitoring was performed that evening after being moved from the surgical suite. The next morning, Mrs. Smith was found to be quadriparetic. A suit was brought against multiple defendants with a significant seven-figure recovery secured. Mrs. Smith and her family had Medicaid coverage and SSI. She had also applied for Social Security Disability Income (SSDI). At the time of settlement, there was no Medicare eligibility, since she had not been approved for SSDI and she wasnât sixty-five.
In the confusing landscape of public benefits and planning issues that arise today for trial lawyers when settling catastrophic injury cases, finding your way can be a daunting task. In the paragraphs that follow, Iâll use Mrs. Smithâs real-world example to identify six key considerations to look out for when youâre settling a case for a catastrophically injured client.
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