What is a Subrogation Lien or Claim?

If you have been injured and incurred medical bills because of the negligence of a healthcare provider, your medical bills may have been paid by Medicare, Medicaid, or a group health insurance company or HMO. If you obtain a recovery from the negligent healthcare provider that caused your injuries, you are required by law to pay back Medicare, Medicaid, or the group health insurance company or HMO for the bills they paid as a result of the negligence of the defendant. These claims of Medicare, Medicaid or your insurance company that they should be paid back are called “subrogation claims.”

The laws and procedures dealing with Medicaid and health insurance programs are different from state to state, and even between insurance companies, so you will need to check with your lawyer about the specifics for your case. Medicare is a federal program and no matter where you are if your bills were paid by Medicare you will have certain obligations to at least partially reimburse Medicare for what it paid. Similarly, if a medical bill for services relating to your injury is unpaid, the unpaid healthcare provider may also have a subrogation claim and need to be paid out of the recovery.

Under Florida law certain hospitals are entitled to a special lien against any malpractice recovery for unpaid medical bills. Under the Florida Medicaid Act it is a crime not to reimburse Medicaid out of a medical negligence recovery for expenses Medicaid incurred as a result of the negligent healthcare provider. Other types of healthcare insurance companies, such as HMOs and regular group health insurance carriers, will negotiate with your lawyer and reduce their subrogation claims depending on the circumstances of your case. Under most circumstances your lawyer should handle this for you.