Personal Injury and Medicare

By: Jonathan Simms

When medicare covers some or all costs related to a personal injury, the injured person, or her family, must submit certain paperwork to the government in certain circumstances. This post is not intended to be comprehensive because the requirements on medicare patients are expansive. Rather, this will provide some information on the requirements that medicare patients may face when receiving a personal injury settlement or judgment.

A medicare patient who is injured, receives treatment covered by medicare, and later receives a settlement or judgment for the injury will be required to notify medicare of any settlement, judgment, award, or other payment made to compensate the plaintiff for the covered injuries. In certain circumstances, medicare is entitled to receive a refund of the payments it made for the covered injuries. The exact amount that medicare will be entitled to receive varies based upon the amount of the settlement and the amounts paid by medicare.

In many cases, the reporting and approval process can take approximately 3 months, or more.

In certain cases, such as a wrongful death action, medicare may not be entitled to receive reimbursement for the funds it paid. Whether medicare is entitled to be reimbursed is dependent on who is injured; in a typical personal injury case, the Plaintiff is the person injured and the person who is the beneficiary of the medicare payments. In a wrongful death action, the injured person is the beneficiary’s survivors and not the beneficiary herself.

If you have been injured and you are a medicare beneficiary, let us advise you on the best way to enforce your rights.

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