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Articles Tagged with reimbursement

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Huntsville Personal Injury AttorneysWhat Personal Injury Cases Are At Issue?

If you are hurt on the job in Alabama, you are likely entitled to work comp benefits. What if you were hurt because someone else was also negligent? You still have a work comp case. If the negligent person was a co-worker, that’s probably all you have. With a few limited exceptions for things like intentional conduct, your employer (and co-workers) are immune from claims outside workers compensation.

Sometimes, the negligent person is a third-party. That is, the negligent person did not work for your employer. If you are hurt due to the negligence of another person (outside your employer), you may also have a separate personal injury claim to recover your damages. In these cases, you likely have BOTH a work comp claim and a negligence claim against the third-party.

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Alabama Accident And Injury LawyersInjured and facing mounting hospital bills? If you find yourself in this situation, the medical bills and charges can be confusing and overwhelming. You probably have many questions. What are my actual medical charges? Sometimes, it’s difficult to tell. How much did my health insurance pay? Why is the hospital charging ten dollars for a single aspirin? None of it makes sense to most patients.

Our medical system suffers from a lack of consistency and lack of transparency in charges. I recently read a great article on LinkedIn that asks the question — Can Price Transparency Actually Lower Health Care Costs? The article discusses several issues, including surprise charges, price gouging and health insurer discounts. The author concludes it’s a “money game” of different prices for different people. This is certainly true for personal injury victims who often suffer the worst impacts of unfair and inconsistent medical costs.

Hospitals attempt to take advantage of personal injury victims for maximum profit. From the moment a personal injury victim enters a hospital, the unjust process begins. Why is the hospital admissions clerk so interested in whether the other driver is at-fault or has car insurance? Hospital greed, that’s why. The same is true for some clinics, chiropractors and physical therapy offices.

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I’ve written on several occasions about Alabama’s unique wrongful death law. Wrongful death claims in Alabama are very different. Chief among the issues that make Alabama wrongful death law different — only punitive damages are recoverable. You cannot recover compensatory damages for actual losses like medical costs.

Many lawyers advertise for wrongful death claims. Yet, they fail to understand fully the impact of Alabama’s unique law. And, this lack of understanding can have a tremendously negative impact on the overall recovery for clients.

An attorney’s entire preparation and trial strategy should be designed for the unique damages recoverable in Alabama. Yet, many attorneys prepare these cases as all other cases. That’s a mistake. It is short-sighted and costly for clients.

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Untitled-design-3-300x300Subrogation. Reimbursement. What do these concepts mean for personal injury cases? When you suffer a personal injury, your health insurer (or plan) pays your medical bills. For many people in Alabama, this means Blue Cross. It may also mean government programs like Medicare, Medicaid or Tricare. These health plans pay your bills. But, they usually have rights to recover their payments from your personal injury settlement. Their rights vary between private and government plans. I’ve addressed that issue in other articles.

The legal issues can be complex. And, understanding the rules (which differ between private and government plans) can make a huge difference in how much money you actually keep. This is an area where a skilled lawyer can really help you save money and maximize your final recovery.

What about wrongful death cases? Do health plans and programs have rights to reimbursement from wrongful death settlements? Does Medicare have reimbursement rights in Alabama wrongful death cases? I mention Medicare specifically because it covers so many people and also carries the weight of the government. While these insurers and plans do have reimbursement rights in personal injury claims, they don’t have the same rights in wrongful death claims.

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Alabama Wrongful Death Attorneys (Blackwell Law Firm)I’ve written some prior articles discussing Medicare’s rights to be reimbursed for medical payments from settlements or judgments in personal injury claims. It’s a topic lawyers should take seriously. As I stated in the past, dealing with Medicare can be an extremely frustrating experience. So, I am happy to report a recent court decision that, to some degree, requires Medicare to play by rules that apply to the rest of us.

On September 29, the United States Court of Appeals for the 11th Circuit issued a decision in Bradley v. Sebelius. The case involved reimbursement claims by Medicare arising out of a wrongful death settlement in Florida. This case is a welcome decision for attorneys frustrated by the experience of dealing with Medicare. On his blog, Tennessee attorney John Day wrote a great analysis of this decision. I agree with John that the case involved some great lawyering by plaintiffs’ counsel.

In the case, the Federal Court rejected Medicare’s far-reaching argument that its own field manual was basically entitled to the force of law. In rejecting those claims, the Federal Court actually stated:

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This morning, workers’ compensation attorney Jon Gelman published an interesting note on his blog about a recent Medicare recovery case filed here in Alabama. The case involves the United States seeking to recover medical payments made by Medicare on behalf of several injured individuals.

This Alabama Medicare case raises an often misunderstood and complicated issue we must handle on a daily basis.  Most injury victims have some type of health coverage that pays their medical bills. For many, coverage is provided by private insurance like Blue Cross. For others, government programs provide coverage. These government programs include Medicare, Medicaid, Tricare or the Veterans’ Administration. When we seek medical care, our particular coverage provides some level of payment. Each plan or program possesses unique rights to be reimbursed for their payments if an injured individual recovers compensation from some third party. So, you need to deal with these issues in your personal injury lawsuit.

Many personal injury attorneys seem concerned with simply signing the client and settling the claim. They want you to “call them” and they want to make a quick settlement with the insurance company. That’s it. It’s wrong. It’s bad for you.

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