No, an insurer generally can’t take reimbursement or place a lien on your pain and suffering settlement on Long Island. When settling a personal injury claim, the settlement doesn’t include compensation for medical bills, lost earnings, or other losses covered by your insurer. As a result, your insurer can’t seek any of the funds you receive in a settlement. This applies to claims filed in Nassau and Suffolk County, and anywhere else in New York.
However, specific exceptions apply, depending on your type of coverage and the amount that you have received. If you are under a self-funded ERISA health plan, or if you used Medicare or Medicaid for healthcare costs, some of your settlement may go to the ERISA plan, or to the government.
Key Takeaways
- Insurers can’t take reimbursement from your settlement because a settlement generally doesn’t cover bills your insurer paid.
- Self-funded ERISA health plans are different and may trigger a claim on your settlement.
- Federal statutes give Medicaid/Medicare mandatory reimbursement rights.
Exceptions on Self-Funded ERISA Health Plans
If your employer’s self-funded ERISA healthcare plan covered some or all of your treatment costs, it may seek reimbursement when you receive a settlement.
- The plan may place a lien on your settlement, equal to the amount they paid for your medical care.
- The plan’s Master Plan Document and Summary Plan Description should clearly outline how settlement liens are enforced.
- You can dispute a lien if the claim is improper. The plan must disclose any documentation, including how it calculated a lien.
Your Long Island personal injury attorney will manage any potential ERISA lien on your settlement, ensuring that it is legal and commensurate with any medical costs paid by the plan. Most importantly, your attorney will verify that the ERISA plan is self-funded, which is the key detail that allows it to seek reimbursement from your settlement.
Medicaid/Medicare Exceptions
Both Medicaid and Medicare have mandatory reimbursement rights.
- Medicaid can claim part of your settlement, equal to the amount allocated to past and future medical expenses. They cannot legally put a lien on funds that are allocated for physical and emotional trauma, or for the loss of enjoyment of life.
- If Medicare has made conditional payments (for example, to prevent the delay of necessary treatment when a primary payer is slow), it has a right to claim reimbursement from a settlement. Its reimbursement must not exceed its payment.
In both cases, a personal injury attorney will review all documentation to ensure that any lien from the Medicaid or Medicare system is accurate and lawful. A lien placed on your settlement isn’t final. It can be invalidated or negotiated if it is incorrect or contrary to established law, including federal and state statutes.
Talk to a Personal Injury Attorney on Long Island
The bottom line is that you are generally protected from any lien on your settlement, except when you are part of a self-funded ERISA health plan, or when you use Medicaid or Medicare Benefits. This doesn’t mean that these additional parties have open access to your settlement. Any lien placed to claim part of your settlement must meet strict standards and can’t exceed the amount that an insurer has paid, or will pay, for your healthcare needs.
The Raimondo Law Firm will fight for your rights, ensure that proper legal standards are upheld, and ensure that you receive every dollar of a settlement that you are entitled to. Case reviews are 100% free. Talk to a Long Island personal injury attorney by calling us at (631) 471-1222 today.
