Personal Injury,
Handled Personally
Handled Personally
Holzberg Legal | Your Maritime and Personal Injury Lawyers
Insurance, Subrogation, & Liens FAQs
Q: Why do I have to repay my insurance company (subrogation/reimbursement)?
A: When your health insurer (private ERISA plan, Medicare, Medicaid, Tricare, VA, FEHBA, etc.) pays bills connected to your injury, they usually gain the right to be reimbursed if you later recover money from the at-fault party. This prevents “double dipping” and ensures the responsible party—not taxpayers or insurers—ultimately bears the cost. The repayment rules vary depending on the type of coverage and plan language.
Q: What’s the difference among Medicare, Medicaid, Tricare, VA, FEHBA, and ERISA plan liens?
A: Each has its own rules:
- Medicare: Pays “conditional payments” and must always be repaid. Failure to do so can jeopardize future benefits.
- Medicaid: State-run, rules differ by jurisdiction. Some states allow reduction for attorney’s fees or hardship.
- Tricare / VA / FEHBA: Federal programs with statutory rights of recovery and limited room for negotiation.
- ERISA Plans: Governed by federal law and plan documents; some are aggressive, others more flexible.
- Private Insurance: Varies by policy language and state law.
Our role is to identify what applies to your case and push for reductions whenever possible.
Q: What if I don’t have insurance?
A: We ensure you still get treatment. Options include provider Letters of Protection (LOPs), charitable programs, or medical funding companies. We also seek to include future medical needs in your settlement demand so ongoing care is covered.
Q: Will liens reduce my take-home?
A: Yes, liens are typically deducted from the gross recovery. However, we aggressively negotiate reductions based on:
- Pro rata attorney’s fees and costs (sharing the burden of legal expenses),
- Hardship considerations, and
- Statutory caps or limits (where available).
The goal is to maximize your net recovery, not just the gross settlement.
Q: What is a hospital lien?
A: Some hospitals file statutory liens for the full billed charges, even if insurance or negotiated rates would be lower. We review whether the lien is legally valid, dispute inflated charges, and negotiate for fair resolution.
Q: What is a Medicare Set-Aside (MSA)?
A: While more common in workers’ compensation cases, an MSA sets aside a portion of settlement funds to pay for future injury-related care that Medicare would otherwise cover. In liability and maritime cases, MSAs are less common, but Medicare’s future interests must still be considered. We document allocations properly so your benefits remain protected.
