If someone’s carelessness caused your injury in Florida, and your health insurer paid medical bills, you may have to repay the health insurer.
The type of health plan that you have will determine how much leverage you have to negotiate your health insurer’s lien.
ERISA Health Plans
Whether or not a health plan will reduce its lien may depend upon whether the plan is an ERISA plan.
ERISA Applies to Most Employer-Employee Plans, But not a Government Entity
ERISA applies to employer-employee plans unless the employer is a government entity or a church. If the employer is a state government or church, state law applies.
If the employer is the federal government, FEBHA applies.
ERISA Doesn’t Apply to Individual Plans
ERISA does not apply to individual plans. State law, Medicare and/or Medicaid govern individual plans. Self-funded ERISA plans are exempt from state law.
Self-funded plans are funded by contributions from employees and the employer.
Fully insured ERISA plans
Fully insured ERISA plans are subject to state law. This is because they are funded by purchased insurance coverage.
How do you know if a plan is self-funded?
The plan language in the Summary Plan Description (SPD) determines if the plan is self-funded or not.
What Happens if You Don’t Pay the Health Insurer from Your Settlement?
If the health insurer has a right to get paid from your injury settlement, and you fail to pay them, they may:
- Sue you.
- Cancel your health insurance
- Reverse payments that they’ve made for your medical bills
Don’t Believe the Health Insurance Subrogation Adjuster
Don’t automatically believe the health insurance subrogation adjuster if he or she tells you that you have to repay them. They may be dead wrong.
I have found this to be the case before which resulted in my clients getting thousands of dollars in their pocket more than what we would have received if we listened to the subrogation adjuster.
Failure to understand this law cold can cost you a tremendous amount of money if the claimed lien is large.
Though there are no guarantees, this savings may cover the attorney’s fees and costs alone.
Health Plan May Have to Reduce Its Lien By Your Attorney’s Fees
Do Health Insurers Have a Lien on an Uninsured Motorist Insurance Settlement?
If the health insurance plan states that its lien also applies to a settlement under Florida uninsured motorist (UM) coverage, it can have a lien on a UM settlement. See Travelers v. Boyles, 679 So.2d 1188 (Fla. 4thDCA 1996).
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