April 24, 2015

What you should know and how we can help

When medical treatment is sought as the result of a motor vehicle accident the medical provider is entitled to payment for services rendered to treat your injuries. The medical provider will first look to the health insurance carrier whether it is a private plan such as Anthem Blue Cross Blue Shield or popular government plans, Medicaid and Medicare. When a personal injury case settlement is being negotiated or after a verdict has been rendered it is important to know your rights and responsibilities with respect to any liens.

Private Health Insurance

Chances are if you have private health insurance it is provided by your employer and falls under the Employee Retirement Income Security Act better known as ERISA. An ERISA plan can recover for damages received from third parties. In laymen’s terms, the effect is the plan can seek reimbursement for medical bills they have paid on your behalf which are directly related to injuries sustained as the result of the negligence of a third party.

In the event your health insurance plan does not fall under ERISA the plans contract language will dictate the insurers right to any proceeds arising from a personal injury award.


The Department of Medical Assistance Services administers the Virginia Medicaid program. To be eligible for Medicaid an applicant must assign to the state any rights to payment of medical care from any third party. In the event the injured party fails to pursue the claim, the state has the ability to pursue reimbursement from the third party. Medicaid is required to be reimbursed from the proceeds of a personal injury award for medical expenses related to the injury.


Medicare has a federal statutory lien for payments made under the Medicare Secondary Payer Act (“MSP”). The Centers for Medicare and Medicaid Services (“CMS”) and the Medicare Secondary Payer Recovery Contractor (“MSPRC”) enforces the lien against the party receiving a personal injury award. Similar to Medicaid, only medical expenses related to the injury are recoverable by Medicare.

Hospital Liens

Pursuant to Virginia Code § 8.01-66.2 each hospital, nursing home, licensed physician, registered nurse, registered physical therapist, pharmacy, or ambulance service shall have a lien for services rendered on care to any person injured in an accident as a result of the negligence or alleged negligence of any other person. The lien shall be for the amount of a just and reasonable charge for the services rendered, not exceeding $2,500 in the case of a hospital or nursing home, $750 for each physician, nurse, physical therapist, or pharmacy, and $200 for each ambulance service.

How we can help

ERISA, Medicare, Medicaid, and Hospital Liens should be scrutinized and negotiated on the client’s behalf. In some instances the lien holder will agree to reduce their lien in an amount proportional to the amount the client has paid in attorney’s fees and costs. We at Cravens & Noll believe even though the case has settled, our job is not over, and we will continue to advocate on your behalf until the job is done.

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