Many people rely on Medicare to pay for their medical care. This federal health insurance coverage can be helpful if a victim suffers a personal injury in an accident. Under Virginia law, every accident victim has the right to pursue damages against the party responsible for the incident that caused the accident, such as the at-fault driver in a car crash or the property owner in a premises liability accident.
Once it is established who the at-fault party is, that party can be legally ordered to pay for the victim’s medical expenses, lost income, pain and suffering, and other losses the victim has suffered because of the injuries.
Injured accident victims covered by Medicare who are awarded damages in a personal injury claim or lawsuit are required to reimburse Medicare for those medical expenses that are related to the accident injury. It is very important to work with your Virginia Beach personal injury attorney when it comes to this requirement because failure to do so can result in financial or even criminal punishment if you fail to abide by Medicare’s rules.
What You Should Do If You Have Been Injured
When a Medicare beneficiary is injured due to someone else’s negligence and pursues a personal injury claim, a common question arises: Does Medicare need to be paid back? The answer is generally yes. Medicare has the legal right to be reimbursed for any injury-related medical expenses it paid on behalf of the injured person once a settlement or court award is received. This requirement is part of the Medicare Secondary Payer rules, which state that Medicare acts as a secondary payer when another party, such as an at-fault driver’s insurance, is primarily responsible.
The first thing a Medicare-covered accident victim should do is report any accidents to the Medical Coordination of Benefits Contractor. Even if a victim fails to report the accident, Medicare officials will likely find out about it through routine account monitoring. If they suddenly see doctors’ visits and treatments, officials will contact the victim to find out about the details of the injury and how it happened.
What If I Receive a Settlement or Award for My Injuries?
If Medicare pays for treatment while a personal injury claim is ongoing, those payments are considered conditional. Medicare expects to be reimbursed once the injured person receives compensation from a third-party liability source. The process usually begins with notifying Medicare that a claim is being pursued. Medicare will then issue a report of the payments it has made related to the injury.
When victims receive compensation in a settlement or award, they must notify Medicare since the agency has the legal right to receive compensation for what they paid out before the victim collects their funds.
When you notify Medicare of your injury or they otherwise find out, they will serve you with a notice of lien that it has placed on any injury compensation you receive. Victims and their attorneys should always compare the lien amount to the amount that Medicare actually paid in medical expenses for treatment of the injury. The lien may also include treatment of future medical treatments that may be needed, so make sure to provide the lien to your attorney.
What If Medicare Is Demanding More Than I Think They Are Owed?
When a victim receives the final lien from Medicare, they may appeal that amount if they feel it is wrong. If no appeal is filed, the victim will have to pay the full amount. Federal laws do not allow any negotiations for lower liens with a patient such as private health insurance companies may do.
The amount that Medicare seeks to recover is limited to the medical expenses it covered that are directly related to the injury in question. Medicare does not have the right to compensation for pain and suffering, lost wages, or other non-medical damages. Additionally, Medicare will reduce its reimbursement claim to account for the injured person’s legal costs, including attorney’s fees. This means the final amount owed is typically less than the total medical payments made.
Failing to reimburse Medicare can lead to serious consequences. Medicare may begin charging interest, initiate collection actions, or even refer the matter to the Department of Justice for legal enforcement. For this reason, it is crucial for Medicare beneficiaries to understand their repayment obligations and ensure that any Medicare lien is properly resolved after a personal injury settlement. Working with a knowledgeable attorney can help ensure that the repayment process is handled correctly and that the injured person retains as much of their compensation as possible.
What Should I Do If I’ve Been Injured in an Accident?
If you’ve been injured due to someone else’s negligence, the first step is to seek medical treatment. Once your immediate needs are addressed, contact an attorney specializing in personal injury cases to discuss your options.
At Shapiro, Washburn & Sharp, we have decades of experience handling personal injury claims. We understand how to navigate the legal process and work with you to maximize the value of your case. Contact our office to schedule a free consultation and let us help you get the compensation you deserve.
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An experienced personal injury attorney with dual licensure in Virginia and North Carolina, Eric Washburn received a B.B.A. in Finance from James Madison University—initially worked in the information technology field before obtaining his law degree from Thomas M. Cooley Law School in Lansing, Michigan. Once an Assistant Commonwealth’s Attorney in Danville, Va., Eric has been recognized by Super Lawyers Magazine as a “Rising Star” Super Lawyer in Virginia since 2014.
