My client was severely injured in an automobile accident. He received medical treatment that was paid for by his employer’s group health insurance policy. The plan is a fully insured health insurance policy.
I was able to settle the injury case for the policy limits of the person who caused the accident, plus the policy limits from my client’s uninsured motorists carrier. Although I obtained policy limits for my client, he was not fully compensated for his injuries because of the low policy limits available.
As is frequently the case, my client’s ERISA health insurer has requested that it be "fully" reimbursed for all money which it expended for medical treatment related to the crash. I objected to paying them back the full amount and suggested that they take about a 90% reduction in what they would accept. They refused.
Today, I filed suit against the health insurer seeking a judicial declaration that the health insurer must substantially reduce what it is seeking. Because this is a fully insured ERISA policy, I believe that the insurer must base its request for reimbursement on Florida Statue Section 768.76. The insurer insists that 768.76 doesn’t apply because this is an ERISA plan. (The insurer is wrong on this).
Based on 768.76, the health insurer must significantly reduce what it is seeking out of the settlement with the person who caused the crash; and it is not allowed to collect anything from the uninsured motorists settlement.
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.
As with many of my insurance cases, there will be no fees or costs for my client in this matter. If I win, the insurance company must pay my fees and costs, and if I lose, I’ll work for free.