My client was injured in an automobile accident.  My client was an HMO member through his employer.  The HMO was issued by Blue Cross and Blue Shield of Florida.  After the accident, Blue Cross and Blue Shield provided some medical services to my client that were accident related, and also provided some services that were not related to the accident. 

When the personal injury case was resolved, Blue Cross and Blue Shield requested reimbursement of the entire amount expended on behalf of my client since the date of accident – even for care that was not related to the accident.

My client’s personal injury lawyer requested that the HMO provide him with a copy of the applicable HMO policy. Although the medical services were rendered in 2007 and 2008, Blue Cross would only give a copy of the 2010 HMO policy.

The personal injury victim hired me to sue to have the lien eliminated and/or significantly reduced. Suit has been filed. I believe that, pursuant to Florida Statute Section 768.76(7), by failing to provide the applicable HMO policy, the insurer has waived any right to request reimbursement. Further, even if the insurance company is entitled to any reimbursement, it cannot seek reimbursement for non-accident related expenses. Finally, to the extent that any right of reimbursement exists, the reimbursement must be significantly reduced pursuant to the formula set forth in Section 768.76.

Repeatedly, I have seen cases where good attorneys pay back liens that do not even exist, or they pay back way too much. Paying back liens that don’t exist, or paying back too much is a disservice to our clients, and can be considered malpractice. The law on health insurance liens is complicated and one should not dabble in it unless experienced.

Frequently, personal injury attorneys will recommend their clients to hire The Nation Law Firm to negotiate those liens. This referral removes any potential liability from the personal injury attorney, and provides a much needed service to their clients.