When Medicare and Personal Injury Lawsuits Collide

If you were injured in a car accident or other serious accident and Medicare paid some of your health bills, your personal injury lawsuit may include reimbursing Medicare for those payments. This is because Medicare has a legal right to reimbursement for the “conditional payments” it provides to injured Medicare recipients. If Medicare is not reimbursed, the government can take legal action against the defendants (insurance companies), the plaintiffs and even the plaintiffs’ attorneys.

That is exactly what happened in U.S. v. Stricker, a federal court action in the United States District Court for the Northern District of Alabama. The government demanded reimbursement for conditional Medicare payments made to plaintiffs who were involved in a large PCB toxic tort settlement. The government brought claims against the defendants and the plaintiffs’ attorneys for failure to properly reimburse Medicare. It did not bring a claim against the injured parties, but it had the legal right to do so.

While U.S. v. Stricker was dismissed on procedural grounds (the government had failed to bring a timely legal action), it cautions plaintiffs and defendants alike to consider whether Medicare should be included in a personal injury settlement or verdict.

The Legal Requirements: Medicare Secondary Payer (MSP)

Under federal law — the Medicare Secondary Payer Statute (MSP) — Medicare does not need to pay for medical services if an individual’s injuries are likely to be covered by workers’ compensation or insurance. However, it will conditionally pay for medical services if payment is not expected immediately. Payments made are “conditioned on reimbursement.” If an insurance company is responsible for the medical payments, it must reimburse Medicare. If it fails to do so, the government may seek double the amount owed in damages.

What This Means for Your Personal Injury Case

When conditional Medicare payments are involved, it can be very difficult to settle a case because the dynamics of negotiation are so different. In other personal injury cases, you can negotiate directly with an insurance company. In cases involving Medicare, it can take months to get Medicare to look at your case and determine what they are owed.

In short, it takes a very long time when Medicare is involved. Very often, Medicare won’t even glance at your case until it settles! This means that you will have no way of knowing what type of payment you will receive from your personal injury lawsuit because it is impossible to guess what Medicare will do.

If you are on Medicare and have been injured in a car accident or other serious accident, contact an experienced personal injury attorney near you to discuss your case.