As personal injury attorneys representing seriously injured victims of car accidents and fall downs throughout Florida, including, Miami, Fort Lauderdale and the Palm Beaches, we know that most of our clients are surprised when we inform them that they must repay their health insurance companies, Medicare or Medicaid for any payments they made towards medical bills for treatment of injuries suffered in an accident.
This repayment requirement is based upon the legal principle of subrogation. Essentially, this means that the health insurance company stands in the shoes of the accident victim. Most states have specific laws which protect the rights of the health insurance companies and Medicaid; Medicare is protected under Federal Law. When we are able to settle an accident victim’s case, we attempt to reduce the amount being sought as repayment by these payers. And, while Florida Law requires private health insurance companies to take various factors into consideration in reducing their subrogation interest, including the attorney’s fees and the injured person’s comparative negligence, state laws protect Medicaid from such equitable reductions.
Now, thanks to a recent ruling from the United States Supreme Court, Medicaid will have to take these factors into consideration in reducing their subrogation claims. In Wos vs. Ema, the Supreme Court held that Federal anti-lien laws prohibit states from enacting their own laws which fail to take determine what portion of an accident victim’s recovery was for the medical bills, versus their lost wages or pain and suffering.
We are hopeful that this “law of the land” will assist us in helping our client’s maximize their net recoveries, by repaying less of their case compensation to Medicaid. Although, given Florida Medicaid’s prior stance on such negotiations, we anticipate needing the presiding judge in each case to Order Medicaid that they must follow the law, just like everyone else.