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Thread: Insurance settles - Medicare wants it

  1. #1

    Insurance settles - Medicare wants it

    My father was hit by a taxi driver. Taxi's fault. Taxi driver had the minimum liability insurance in his state -$100k. His insurance company didn't put up much of a fight, and agreed my dad deserved it.

    However, Medicare wants it - to cover the bills they have already paid to take care of my father. Of course, the hospitalization/therapy/medical expenses for my father have been very high, and we are grateful that his insurance (Medicare/Blue cross) has covered nearly all of it. But my parent's out of pocket expenses have of course been very significant ... you all know what it's like.... and they have yet to modify their home, get an accessible vehicle, think about future therapy costs etc... My father was the sole income source for my parents before his accident.

    Has anyone had success with their lawyer ?negotiating with insurance company liens to try to keep more of any settlement/insurance monies since the long term costs of spinal cord injury are so astronomical for the patient/family? If so, how? Our lawyer seems to be hoping for 1/3 of the money, at best. He has never had a case involving SCI before.

    It's just frustrating, as this amount of money is a drop of water in the Medicare ocean, but it is a fortune to my parents.... I guess it will become our family's contribution to the Nation's economic bailout.....

  2. #2
    We are still fighting with our insurance company for their lien on my settlement.

    $100,000 is a lot of money. Remember that the lawyer also gets his 1/3 plus expenses upfront before your family sees a penny. Wait until you see his expenses for photocopying!

    He may not smell a big profit here and could be less aggressive with your

    Not having any experience with SCI cases is troubling. Are you locked into a representation contract with him?

  3. #3
    Did you have a life care plan done by a qualified person? Have you already agreed to this piddly settlement??? Your attorney should have been going after the big pockets (the taxi company) and not settle for something that is likely to cover less than a year of his medical expenses.

    Yes, if you get a settlement, the attorney gets their cut first (usually 1/3 plus expenses), then the medical insurance (private insurance, Medicaid, Medicare, etc.), and then, if there is anything left, he gets it. If it goes into his bank account it can also make him ineligible for Medicaid or SSI. A structured settlement has some advantages in this, as may a special needs trust, but if the settlement has already been paid, it may be too late. A specialty attorney, and a life care plan by an SCI expert are critical in these decisions or people are very likely to get screwed over. The taxi-driver's insurance company is not going to take care of your dad. They settled because they know that $100,000 for a SCI is a steal.


  4. #4
    The problem is that my dad was hit by a taxi driver who works independently - as do a huge proportion of taxi drivers in NYC. Meaning there is no taxi company to sue. Just the individual driver. So there was no more money to go for, as the driver was certainly not a moneybags. We have not pushed the lawyer to sue to taxi driver himself.... it did not seem like the right thing to do.

    So the $100K was the total amount available from the taxi driver's insurance. That settlement has been accepted. But there is a chance that there may be some coverage through my father's underinsured driver personal policy, although his insurance company has been hedging... we'll see.

    Yes, I do suspect that the lawyer does have disincentive as the potential settlement is not huge. But geez..... the amount of money these guys make for such minimal time invested. It's ridiculous!

    Our attorney is a personal injury attorney - "friend of a friend" - with an impressive history of ethical behavior with a background in human rights issues. But no experience with spinal cord injury - they say my father's case is the most devastating they have seen. I will have to look into the contract that my mom signed....

    I also did ask the lawyer about making a life care plan. Well, actually I only spoke with his wife/assistant about that. They were less enthusiastic, as the projected costs for my father's injury so outstretch the money available that they didn't think it would help. But now that I realize that Medicare/Blue Cross will want their cut (?!?!? all of it), I am wondering if a life care plan would help? So I actually put together a "life care" plan myself, as I have quite a bit of expertise in the medical arena. But I suspect this would need to be prepared from an "impartial" agent to carry more weight?

    So, I guess my question is this. When you are fighting with medical insurance companies who have liens,..... has anyone had success fighting Medicare with a "life plan" showing the grave financial burden the family has to carry? Fighting Medicare seems daunting to me..... what lawyer would want to do that?

    And does anyone have recommendations for finding someone to complete a life plan? Although it irritates me to think someone will charge us/our lawyer a few grand to make one, when I am sure they will likely copy most of the one I did.....

    Sorry... thanks for listening.

  5. #5
    It would not hurt to give your attorney a copy of your projected future expenses for your Dad. He can present them to insurance. You've done the work so give it a try.

    Your attorney would have to hire a life care planner. My understanding is that these are used alot in catastrophic workers comp and big multimilliion dollar payouts like from medication suits against drug companies. Ask him again though.

    I read your post detailing your fathers injuries. Protect whatever money he gets from the settlement because he is going to need long term medical care.
    Ask the attorney about Special Needs Trusts and Structured Settlements.
    If he needs long term care and Medicaid is the only answer, the settlement will blow his chances unless its protected.

  6. #6
    thanks cm and KLD - it is helpful to hear from your knowledge/experience.

    Yes, I have given my life plan to our lawyer. They thought it was useful. And daunting.

    I appreciate your advice regarding setting up a trust for any settlement monies. However, since they are likely going to be spent within the next 1-2 years (since they will not likely be very large) on reimbursing things already bought/home changes/car/therapy etc... it likely wont be as critical to protect them long term. They'll be gone!

    Or can Medicare ask for money back for future expenses, like Medicaid can, if you don't protect the money? He will not likely be downspending to become eligible for Medicaid soon. He's just eating away his retirement savings, with large mouthfulls..... I guess they are fortunate they saved their whole life. It's just not the way they had hoped to spend it.

    This keeps me up at night. At least it isn't his ICU monitors keeping me up at night. Turn every 2 hours... turn every 2 hours.....

    My dad turned 65 the month before his injury, so Medicare became his primary insurance actually in the middle of his hospitalization.

    So....... has anyone successfully fought a medical insurance company lien?

    Anyone... anyone.....?

  7. #7
    Also any money medicare spends on this injury in the future is also payable back to....So even if you get 500k....they still end up getting it in the long run.

    So you get the injury...only one that makes any money is the bloodsucking lawyer.

    I think you should be able to keep the money because you have the loss.

    That law needs to be fixed.

    Why I say never settle for medical if you don't have to.

    If you live in a no-fault state they owe you medical for life.


  8. #8
    hmm.... too bad they moved this thread. I suspect fewer will see it... sorry - selfish of me.

    Thanks so much for your message Art. It has me in a tailspin! Please forgive my questions but......

    So you mean.... if there is $100k, and today the lawyer gets 1/3, medicare takes 1/3, and my dad gets 1/3, then medicare can come back tomorrow and ask for some of my dad's 1/3 back if he goes to a doctor's appointment related to his injury? And they can't protect it with a Trust? What is "the law" you refer to? That Medicare gets all?

    What if he's already spent > $30K in expenses (home changes, bathroom equiptment, transportation, lost income etc...)? Then he gets to keeps it? Is that what you mean "because we have the loss"?

    And "no-fault" is still a mystery to me. My dad lives in Illinois, but was hit by a cab in New York - a "no-fault" state. We still don't understand very well how no-fault works, since we don't have it in Illinois. All we know is that they paid $50K (max of the no-fault in NY, as I understand) for my dad's ICU care while he was in the hospital. That no fault $ came from the taxi driver's insurance company, I assume? Not the state, right? My parents took a separate settlement from the taxi driver (and his "taxi company" of one person) for what they were told was his maximum liability policy of $100K. But are you saying that they made a foolish mistake and that this no-fault policy could have given them additional medical coverage for the rest of his life? That perhaps it could have covered physical therapy for the rest of his life? But they live in Illinois, not NY... maybe it doesn't matter?

    If this is true, our lawyer is truly awful and I've made a horrible mistake.

    Although my parents would have had Medicare anyway (and a secondary health insurance policy) that would have paid first, I assume.

    Any thoughts Art (sorry to drag you in....).
    Last edited by hlh; 10-07-2008 at 12:38 AM.

  9. #9
    hlh: don't forget. A life insurance policy (e.g. second to die) placed inside your dad's special needs trust could be exactly what you need.

    Example: a second-to-die life insurance policy is purchased. The policy is issued in your mom's name for let's say $1mm. The beneficiary upon death, is the trust which then avoids probate, estate taxes, medicaid review, etc. The $1mm is now in the trust and can be utilized, depending upon the trust language, for needs of the family. The premiums paid will be no where near the $1mm value but later could provide much needed income, assisted living care, etc.

    The Trust is the way to go if not simply for the fact that any monies contributed (church, fundraiser's, gifts, etc.) to your father's care and well-being would not be assessed against his government benefits.

    Good luck.

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