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How Are Future Medical Expenses Calculated In A Personal Injury Settlement?


Reimbursement with respect to medical bills already paid is a determination of law that has to be applied to the facts of each case, which determines whether you are receiving duplicative benefits, and if you are receiving a duplicative benefit, the law is clear that receiving a duplicative benefit does not result in a double recovery. With respect to future medical care that is handled by medical expert advice, usually in the form of a letter stating the nature of your injuries, and what type of medical care you are receiving, probably the naught is going to be incurred because of your injuries, and the lingering effects of the collision.

Future medical care may then have to be analyzed by another expert to determine the value of that future medical care because most doctors do not have a grasp on the specifics of the value of future medical care. Sometimes, you will have to have someone else look at the codes used by the doctors for the different medical treatments recommended, and assigned a dollar value for your continuity for those particular codes of future medical care.

Should Someone Pay The Medical Bills As They Come In Or Should They Wait For The Claim To Be Resolved Before Paying The Bills?

Generally speaking, you want those bills paid as they come in. Most people have a health insurance policy or an auto medical pay policy that will pay for the medical bills, but if they do not have either, and if they can pay their medical bills as they are coming in, they can help avoid some of the problems at the time of the settlement. It becomes a bit more problematic when the medical bills become outstanding, and you have to negotiate with healthcare providers over the division of the settlement proceeds, or the healthcare provider has written off the medical bills.

They do not get the full value of that considered by the insurance company when determining the value of your case. Since the healthcare provider as a loss, under Kansas Law, has written off the bill, you do not get the full value of that bill when considering the total value of your case. So if you can afford to pay the bill, it is always better to go ahead and pay it, and avoid collections, and dealing with this issue while you are trying to recover.

When Do Clients Discover That The Parties Involved In The Settlement Get Recompensed?

Compensation is dependent upon the nature of the right of reimbursement or the lien that is being claimed under Kansas law with a typical automobile accident case. We usually see three types of liens asserted. One is the no-fault lien, carried by your own auto insurance policy that has a right of reimbursement if your recovery is a full recovery from the person who caused the accident. It is a lien that is negotiable with insurance companies, and in so many cases that lien is waived, or reduced substantially.

The second type of lien we often see is the hospital lien, which under Kansas law is subject to a determination with the district court. If you have a situation where you do not recover fully, all of the damages you sustained in that accident and your hospital lien are larger than $5000, then you can go to court, and have a judge decide whether it is fair to have the hospital take a substantial portion of your personal injury settlement. The third type of lien is an ERISA claim, which is a claim held by a self-funded insurance plan that looks and acts like a healthcare plan, which has paid part of the medical bills from your automobile case.

They will often assert a right of reimbursement from your personal injury settlement, and you need to have a lawyer carefully look over the plan to determine under the law, that this in fact, is enforceable, because there are many different plans with different verbiage that has to be looked over by an experienced lawyer. Your attorney should be able to determine whether it has the value of language in the self-funded health plan that allows for reimbursement. In those plans, the first thing a lawyer does is determine whether the plan is, in fact, self-funded, or just like every other insurance policy. If it is a true health insurance policy under Kansas law, then there is no right of reimbursement under Kansas law, and that lien can be defeated.

Therefore, anytime you are dealing with an ERISA plan, you need to consult with a lawyer because those are quite complex plans that need to be evaluated.

For more information on Future Medical Expenses, a free initial consultation is your next best step. Get the information and legal answers you are seeking by calling (316) 854-4601 today.

 Law Office of Riedmiller, Andersen and Scott LLC

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