Health insurance subrogation involves much more than simply making demands on negligent tortfeasors. For example, a common scenario arises when a health insurance company and a workers’ compensation carrier may simultaneously be called upon to pay for the same injury. Health Plans often pay medical bills that are later discovered to have been the result of a work-related accident and covered under a workers’ compensation policy. If an employee’s workers’ compensation claim is denied, the employee often has no choice but to submit his medical bills to his health insurance company only later to discover that the workers’ compensation claim is accepted, or the employee prevails on the claim at a workers’ compensation hearing.
Depending on the state you are in, a health insurer may choose to pay the benefits while a workers’ compensation claim is pending and then seek reimbursement directly out of the workers’ compensation recovery. A typical health policy will contain an exclusion for accidents covered by workers’ compensation. Furthermore, most health plans have language providing that the health carrier has a right of reimbursement in a situation where the injury from which benefits paid is later determined to be work-related. The problem is how to deal with benefits paid by a health insurer for an injury which later turns out to be work-related and covered by a workers’ compensation policy.
In states which allow health plans and other entities to intervene into a pending workers’ compensation claim, Matthiesen, Wickert & Lehrer, S.C. (MWL) assists its clients in seeking reimbursement directly out of pending workers’ compensation claims. For example, in California, state law provides that a health plan has a specific right to intervene into a workers’ compensation proceeding and seek reimbursement. MWL aggressively pursues workers’ compensation lien rights on behalf of our clients whenever state law allows entities to intervene into pending workers’ compensation claims. Through the use of trial briefs, exhibit binders, and expert witnesses, MWL is able to maximize recoveries for our health insurance clients whenever an injury is determined to be caused by a work-related accident.