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Clearing Claims: Negotiating Health Insurance Liens in PI Cases

By Gabriella Khorasanee, JD | Last updated on

It's another Monday, and that means one thing: we're talking about liens (we know, as if it wasn't bad enough that it's Monday)! This week, we're letting you in on some negotiating tips for health insurance liens in personal injury cases.

As with all liens, you'll want to make sure that you negotiate all liens prior to finalizing the settlement with the third party so that you have more leverage. Once the settlement is finalized, you have very little wiggle room.

1. Review

First things first, get a copy of the contract and review it. If the contract is not governed by ERISA, move on to steps two and three below. If the contract is governed by ERISA, read our tips for negotiating ERISA liens.

When you review the contract look for any possible limitations: Does the insurance company have a right to make a particular claim? Has the insured waived certain defenses? Figure out what settlement funds the insurance company is entitled to go after.

After you review the contract, ask the insurer for an itemized copy of their claim for reimbursement. Go through each line item and look for discrepancies.

2. Reduce

There are several ways to reduce lien claims made by health insurance companies including: (1) getting credit for co-pays; (2) reducing for unrelated or unreasonable charges; (3) reducing for actual recovery of medical bills; (3) reducing to the statutory cap; (4) reducing for proportionate share of statutory cap; (5) reducing for comparative fault; (6) reducing for the common fund doctrine; and (7) reducing based on the made whole rule.

3. Play Nice

Remember that saying your mom always said? "You can catch more flies with honey than with vinegar." Well, that's true when it comes to negotiating liens. You'd be surprised how much more (and how much easier) it will be to accomplish your goals if you establish a good rapport with the lien claimant. Be nice, and use common sense to get your point across. That way, when you tell them it's better to get paid something now, rather than possibly nothing later, they will trust you.

For a more in-depth overview of negotiating tips for health insurance liens in personal injury cases, please read our practice guide. Remember, sharing is caring -- let your colleagues in on these useful tips too.

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