Medicare and Car Accidents

Any time you can get Medicare to pay for medical bills after a car accident, it is a blessing. Keep in mind the fact that they are a secondary payor under their own rules and they have the right to refuse to pay until the at fault driver's car insurance has refused to pay. We do see a number of situations where Medicare steps in and does pay.

The question becomes, what is owed out of any settlement if Medicare paid for some of the treatment. The answer is you and your lawyer need to engage in a frank discussion with Medicare about the settlement. Your lawyer cannot get cute and allocate some of the settlement money specifically to pain and suffering or lost wages to minimize or eliminate Medicare's reimbursement rights. Here is their manual statement on the subject:

"Medicare Secondary Payer Manual

Chapter 7 Contractor MSP Recovery Rules

50 - Recoveries From Liability Insurance Including No-Fault Insurance,

Uninsured, or Under-Insured Motorist Insurance

50.4.4 - Designations in Settlements

(Rev. 1, 10-01-03)

In general, Medicare policy requires recovering payments from liability awards or settlements, whether the settlement arises from a personal injury action or a survivor action, without regard to how the settlement agreement stipulates disbursement should be made. That includes situations in which the settlements do not expressly include damages for medical expenses. Since liability payments are usually based on the injured or deceased person's medical expenses, liability payments are considered to have been made "with respect to" medical services related to the injury even when the settlement does not expressly include an amount for medical expenses. To the extent that Medicare has paid for such services, the law obligates Medicare to seek recovery of its payments. The only situation in which Medicare recognizes allocations of liability payments to nonmedical losses is when payment is based on a court order on the merits of the case. If the court or other adjudicator of the merits specifically designate amounts that are for payment of pain and suffering or other amounts not related to medical services, Medicare will accept the Court's designation. Medicare does not seek recovery from portions of court awards that are designated as payment for losses other than medical services."


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