ERISA Medical Lien Reimbursement Rights

The majority of people who are injured in an accident and need to seek medical care will need to pay their medical bills and get reimbursed once their personal injury claim settles. However, if you are fortunate enough to have health insurance, your Orange County personal injury attorney can set up a lien process wherein in your carrier will pay your medical fees. Once your case comes to a conclusion, the insurance company will be reimbursed from the settlement or judgment.

The amount of reimbursement generally varies depending on the nature of your health insurance contract. For instance, if you have a medical insurance plan that is considered to be ERISA-based, special rules will apply.

What Is an ERISA-Based Health Insurance Plan?

ERISA (Employee Retirement Income Security Act), governed by the federal government, oversees all types of private employer-sponsored health plans. It governs administration of the plans, certain protections for enrollees and a few coverage requirements.

If you get health insurance through a private employer, your plan is most likely ERISA-based, in which case certain rules will apply with respect to a medical lien reimbursement.

Medical Lien Reimbursement Under ERISA-Based Health Care Plans

ERISA-based plans generally nullify the beneficial California-based laws that govern the amount of reimbursement your Orange County personal injury attorney will be required to provide to the insurance carrier.

The major difference in ERISA-based plans is that they are not subject to the Made Whole Rule or the Common Fund Doctrine. In other words, once your personal injury case comes to a conclusion, the carrier will expect 100 percent of the bills paid, leaving less money in your pocket.

Although ERISA-based plans can pursue 100 percent reimbursement, most are willing to work with personal injury attorneys in negotiating some sort of reduction in their reimbursement request. This is based on the reasoning that without the help of your Orange County personal injury attorney, they would have not received any type of reimbursement.

Call Us Today!

For more information about ERISA medical lien reimbursements, you should call the Law Offices of Samer Habbas at (888) 848-5084 to schedule a complimentary consultation with one of our experienced Orange County personal injury attorney.