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Challenges in Personal Injury Cases Involving Medicare or Medicaid

Challenges in Personal Injury Cases Involving Medicare or Medicaid

November 9, 2023
By Willis, Willis & Rizzi, Personal Injury Attorneys Akron
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Challenges in Personal Injury Cases Involving Medicare or Medicaid

When you have personal injury cases that involve Medicare or Medicaid, there are a wide range of challenges to understand when seeking resolution to the case. In fact, health insurance in general whether it is Medicare, Medicaid, Medicare advantage programs or private health insurance, all of them have some form of subrogation or reimbursement rights. These are two distinct different rights. In essence it boils down to money that is spent by these government programs or insurance companies for your medical care as a result of injuries sustained in a collision or other personal injury, will be looked upon as due back to the government or health insurance company.  Generally, they will be looking to be reimbursed by you when you are paid by the responsible insurance company.

Medicare (governed by federal law) and Medicaid (governed by state law) both have statutory rights to be reimbursed by you or the at fault party for the money they have spent on your injury related care. And if you have injuries that are of a more permanent nature as a result of the accident, that will require ongoing care and treatment, Medicare and Medicaid may be looking for reimbursement now for any future expenses that they will pay related to that care as well. Failure to address these claims for reimbursement could jeopardize your future health coverage.

With private health coverage their rights to get paid back are written into the contract for coverage. The contract will spell out what rights they have for reimbursement.

In the field of personal injury law, the majority of law firms and personal injury attorneys are mass marketers, and their business model is similar to an assembly line. They spend vast amounts of money to get personal injury cases in their doors and their approach is one of volume, so they are looking to settle your case and move you down the assembly line so they can move on to the next case and keep the assembly line moving. These types of law firms may not take the time to fully investigate the case to get the best outcome for their clients, they have to keep the machine moving.

What Sets Willis, Willis & Rizzi Apart

As an example, at Willis, Willis & Rizzi when we are working on a personal injury case involving Medicare or Medicaid, we will investigate what they have paid for your medical bills. However, Medicare or Medicaid will not accept our word for what was spent on your medical bills, they will do their own analysis. And the fact is, their analysis is often wrong! If you are on Medicare or Medicaid you may have other health issues for which you are receiving care. If you are dealing with COPD those medical expenses have nothing to do with the broken leg you had in the collision. But Medicare and Medicaid’s approach is to look at the date of the accident and then take all bills from that date forward and say they are related to the accident and will want reimbursement for those expenses. A lot of law firms that have an assembly line of cases, when they get a number from Medicare or Medicaid, they just simply pay it back – with your money – without taking the time to fight to get the Medicare or Medicaid number reduced!

With private health coverage we demand a copy of the controlling contract for health coverage.  If they cannot produce it, then our position is they have no right for reimbursement. If they do produce it, then we review the contract with a fine tooth comb to see what rights they truly have. There is also federal and state law that can apply to these health coverages that can have a bearing on what if anything they are entitled to in reimbursement.  We will fight to get the best possible outcome in these matters – as if your money at issue – was our money.

At Willis, Willis & Rizzi we will take the time to go through the process with Medicare, Medicaid and/or any private health insurer and appeal what their assessment says they are due. We will ensure that they only receive reimbursement for the bills they paid that are related to the injury from your accident and for which they may be entitled to be reimbursed. This is important because the reality of personal injury cases is that often there is not a huge amount of insurance money available to cover your injuries. The State of Ohio minimum insurance coverage is $25,000 – that is not a lot when you are dealing with any type of significant injury. And when Medicare, Medicaid or a private health insurer step in and say they are owed $20,000 and your attorneys simply accept that and pay it – with your money – while taking their fee – there is very little if anything left for the injured party.

At Willis, Willis & Rizzi we will advocate on your behalf with Medicare, Medicaid or private health insurers, we will investigate and report on what medical bills are related to the accident. And when we are dealing with limited amounts of insurance coverage, we often will argue for a hardship discount since there are limited funds available to cover all the bills and make the person whole.  This is all part of the services we provide for our clients. 

This is what sets Willis, Willis & Rizzi apart from other personal injury law firms. Often the best outcome for the client is not just collecting the most money available but saving the most on the back end as well. Since attorney fees are paid on the amount collected there is little incentive for mass marketers to worry about what amount they save for you. Contact us today at 330-535-2000 for a free consultation with a personal injury attorney and let us help you.

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For A Free Personal Injury Case Consultation


    Willis, Willis & Rizzi Co., L.P.A

    Personal Injury Attorneys

    670 West Market St. 
    Akron, Ohio 44303


    Willis, Willis & Rizzi, Personal Injury Attorneys Akron

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