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Snyder: Who Paid Medical Expenses in Past? Who Pays in Future?

  • State: California
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Injury claimants are most likely to accept a settlement offer that takes care of liens without wiping out the entire settlement and provides a safety net for their future medical care.

Teddy Snyder

Teddy Snyder

In mediation, I try to prompt negotiators to present proposals that show how a demand or offer addresses these issues. To do this, negotiators must review past medical expense records, understanding that claimants may hopscotch among payers or have concurrent payers as their status changes.

Private insurance: Most Americans under 65 get health insurance through their or a family member’s employer. Some people may have purchased health insurance through an Affordable Care Act exchange. Depending on their income, they may receive subsidies to reduce the premium.

Claimants who are no longer able to work and now have a preexisting condition may have transitioned from an employer’s plan to an Affordable Care Act plan. Some claimants may be self-procuring health insurance, including Medicare enrollees buying supplemental plans known as Medigap insurance and Part D prescription drug plans.

Workers' compensation: Will have paid past medical expenses for an accepted industrial injury.

Medi-Cal: Pays medical expenses for low-income individuals who qualify.

Medicare: Provides medical care for disabled people who have qualified for Social Security Disability Insurance after 30 months, as well as for Medicare enrollees who have reached normal retirement age.

Out of pocket: Those with the financial ability to do so may self-pay when they lack insurance or want a procedure the insurer has denied or stalled.

On a lien: When an attorney refers the client to a medical provider who provides services without charge, the provider has a lien on the ultimate case proceeds.

Every one of these possibilities (other than expenses paid out of pocket by the rare individual who can afford it) can give rise to a lien that must be resolved before settlement proceeds can be distributed. Negotiators should determine the extent of such liens before coming to mediation and be prepared with a plan to fund the injured person’s future medical needs.

Attorney Teddy Snyder mediates workers' compensation cases throughout California. She can be contacted through WCMediator.com.

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