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Insurance Company Liens and Personal Injury Suits: ERISA and NEW YORK'S NO LIEN LAW STATUTE - Part 2 of 2

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Health insurance companies that want reimbursement for medical expenses related to a personal injury settlement or court award should always be verified before you pay the claim. The names of a health insurance company do not automatically grant that company a reimbursement.

The health plan and documents are where it is stated if the health insurance company is entitled to a reimbursement.

The plan must state that:

  • It is self-funded (an employer pays out of its own funds) and qualified for ERISA
  • It is entitled to a reimbursement when there is a settlement or court award
  • It intends to pursue reimbursement
  • Form 500 filed with the IRS to prove that it is self-funded

You also have to look closely what the request for reimbursement is about. For example: if in a car accident you suffer from a back injuries and are also seeing an allergist or an eye doctor that is unrelated to the car accident, then there is no valid claim for reimbursement for the allergy expenses. The company will make a claim for all billing for a specific period of time, but if they do have a lien, then they can only recover costs related to the accident.

Even where the health insurance reimbursement claims have been verified, there may be ways to reduce the amount. You should work with your attorney to review the medical claims asserted under a lien.

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