Page 1 of 2 1 2 LastLast
Results 1 to 10 of 11
  1. #1
    Join Date
    May 2007
    Posts
    6

    Default Policy Limits and HMO Liens in California

    October '95 I was a passenger in a friends vehicle when he failed to make a turn. Although we were traveling at a low speed (under 25MPH) there was no road on the other side of the road he was to turn onto, just a drop into a dry canal. The result was minor injuries for my friend, major damage to his vehicle and a shattered pelvis from my femur being driven through the hip socket, along with a fractured spine. The hip eventually required replacement surgery to allow me to walk again but due to the spine injury I have been unable to return to work and am now on SSD. Most likely I will never be able to return to work. AT age 55 I am now reduced to an Income that is less than 1/3 of my working income. My friends auto insurance has sent me letters offering me $100,000. which they claim is the max value of his policy for individual claims. They also inform me that my HMO that paid for all of the injury claims from the accident and the hip replacement has a lien on any settlement that I accept. This lien is in the area of $85.000. which leaves me with very little compensation for my loss. I'm of a mind to just let the settlement go rather than letting the HMO which I have been paying for for years recoup any of their expenses even if it means I will be bankrupt a few months earlier than I would be if I accept the offer. Any comments or advice that could change my situation?

  2. #2
    Join Date
    Mar 2005
    Location
    Michigan
    Posts
    28,906

    Default Re: Policy Limits and HMO Liens in California

    Try contacting the HMO and negotiating with them to reduce their lien.

  3. #3
    Join Date
    Jul 2007
    Location
    Virginia
    Posts
    8

    Default Re: Policy Limits and HMO Liens in California

    You said: "My friend's auto insurance has sent me letters offering me $100,000. which they claim is the max value of his policy for individual claims" I highly doubt the insurance company would just "claim" that is all the coverage your friend purchased...I am sure that is all the coverage he purchased. Insurance companies would be committing a seriuos crime if they in fact had more coverage than what they said.

    As for the lien, it is common practice for a health insurance companies to place a lien against settlements, basically they want their money back. You need to contact your HMO and ask them for the contract language that gives them the right to place a lien against a 3rd party settlement, then once the provide that, as Aaron said, you can try negotiating the lien amount down. How much was your medical bills? Just curious.

    Also, have you checked with your auto insurance carrier to see if you have Underinsured Motorist Coverage? You need to check on that to see what your limits are.

    Good luck.

  4. #4

    Default Re: Policy Limits and HMO Liens in California

    Twelve years is a long time. Have you filed suit?

  5. #5
    Join Date
    Apr 2007
    Location
    Il.(near StL,Mo.)
    Posts
    5,252

    Default Re: Policy Limits and HMO Liens in California

    Right, you could have filed suit against the driver for more than the amt. his ins. co. is offering to pay.
    I noted that original thread started/from 5-9-07 (2 mos. ago) - OP may not come back to forum but two other posts prior to mine today.

  6. #6

    Default Re: Policy Limits and HMO Liens in California

    Assumming you want to take the $100,000 offer because it is another point of discussion if you want to sue beyond the limit of the insurance policy.

    If it has not been 12 years ago this law will help you. According to this law they can only put a lien on 1/2. So that would be $50,000 if you don't have a laywer.

    If you get a laywer they can only get 1/3. I would offer to settle with the HMO for 1/3 and only around 1/3. Because you already have a settlement offer. If you get an laywer it is automatic that your HMO will only get 1/3. If the HMO does not pay ball you can always get an attoney pay him/her as little as possible to rubber stamp the process only give 1/3.

    Also check out this web site. http://www.harp.org/subrog.htm. Because I think you have to be made "whole". But there are acceptions.




    3040. (a) No lien asserted by a licensee of the Department of
    Managed Care or the Department of Insurance, and no lien of a medical
    group or an independent practice association, to the extent that it
    asserts or enforces a lien, for the recovery of money paid or payable
    to or on behalf of an enrollee or insured for health care services
    provided under a health care service plan contract or a disability
    insurance policy, when the right of the licensee, medical group, or
    independent practice association to assert that lien is granted in a
    plan contract subject to the Knox-Keene Health Care Service Plan Act
    of 1975 (Chapter 2.2 (commencing with Section 1340) of Division 2 of
    the Health and Safety Code) or a disability insurance policy subject
    to the Insurance Code, may exceed the sum of the reasonable costs
    actually paid by the licensee, medical group, or independent practice
    association to perfect the lien and one of the following:
    (1) For health care services not provided on a capitated basis,
    the amount actually paid by the licensee, medical group, or
    independent practice association pursuant to that contract or policy
    to any treating medical provider.
    (2) For health care services provided on a capitated basis, the
    amount equal to 80 percent of the usual and customary charge for the
    same services by medical providers that provide health care services
    on a noncapitated basis in the geographic region in which the
    services were rendered.
    (b) If an enrollee or insured received health care services on a
    capitated basis and on a noncapitated basis, and the licensee,
    medical group, or independent practice association that provided the
    health care services on the capitated basis paid for the health care
    services the enrollee received on the noncapitated basis, then a lien
    that is subject to subdivision (a) may not exceed the sum of the
    reasonable costs actually paid to perfect the lien, and the amounts
    determined pursuant to both paragraphs (1) and (2) of subdivision
    (a).
    (c) If the enrollee or insured engaged an attorney, then the lien
    subject to subdivision (a) may not exceed the lesser of the following
    amounts:
    (1) The maximum amount determined pursuant to subdivision (a) or
    (b), whichever is applicable.
    (2) One-third of the moneys due to the enrollee or insured under
    any final judgment, compromise, or settlement agreement.
    (d) If the enrollee or insured did not engage an attorney, then
    the lien subject to subdivision (a) may not exceed the lesser of the
    following amounts:
    (1) The maximum amount determined pursuant to subdivision (a) or
    (b), whichever is applicable.
    (2) One-half of the moneys due to the enrollee or insured under
    any final judgment, compromise, or settlement agreement.
    (e) Where a final judgment includes a special finding by a judge,
    jury, or arbitrator, that the enrollee or insured was partially at
    fault, the lien subject to subdivision (a) or (b) shall be reduced by
    the same comparative fault percentage by which the enrollee or
    insured's recovery was reduced.
    (f) A lien subject to subdivision (a) or (b) is subject to pro
    rata reduction, commensurate with the enrollee's or insured's
    reasonable attorney's fees and costs, in accordance with the common
    fund doctrine.
    (g) This section is not applicable to any of the following:
    (1) A lien made against a workers' compensation claim.
    (2) A lien for Medi-Cal benefits pursuant to Article 3.5
    (commencing with Section 14124.70) of Chapter 7 of Part 3 of Division
    9 of the Welfare and Institutions Code.
    (3) A lien for hospital services pursuant to Chapter 4 (commencing
    with Section 3045.1).
    (h) This section does not create any lien right that does not
    exist at law, and does not make a lien that arises out of an employee
    benefit plan or fund enforceable if preempted by federal law.
    (i) The provisions of this section may not be admitted into
    evidence nor given in any instruction in any civil action or
    proceeding between an enrollee or insured and a third party.

  7. #7
    Join Date
    May 2007
    Posts
    6

    Default Re: Policy Limits and HMO Liens in California

    Quote Quoting lwpat
    View Post
    Twelve years is a long time. Have you filed suit?
    Sorry that was a brain fart. It should read '05.

  8. #8
    Join Date
    May 2007
    Posts
    6

    Default Re: Policy Limits and HMO Liens in California

    Quote Quoting Betty3
    View Post
    Right, you could have filed suit against the driver for more than the amt. his ins. co. is offering to pay.
    I noted that original thread started/from 5-9-07 (2 mos. ago) - OP may not come back to forum but two other posts prior to mine today.
    I'm not willing to try and sue my best friend of more than 20 years.
    The only asset he has is his home which he has opened to me in time of need in the past.

  9. #9
    Join Date
    May 2007
    Posts
    6

    Default Re: Policy Limits and HMO Liens in California

    Quote Quoting plumbertom1
    View Post
    October '95 I was a passenger in a friends vehicle when he failed to make a turn. Although we were traveling at a low speed (under 25MPH) there was no road on the other side of the road he was to turn onto, just a drop into a dry canal. The result was minor injuries for my friend, major damage to his vehicle and a shattered pelvis from my femur being driven through the hip socket, along with a fractured spine. The hip eventually required replacement surgery to allow me to walk again but due to the spine injury I have been unable to return to work and am now on SSD. Most likely I will never be able to return to work. AT age 55 I am now reduced to an Income that is less than 1/3 of my working income. My friends auto insurance has sent me letters offering me $100,000. which they claim is the max value of his policy for individual claims. They also inform me that my HMO that paid for all of the injury claims from the accident and the hip replacement has a lien on any settlement that I accept. This lien is in the area of $85.000. which leaves me with very little compensation for my loss. I'm of a mind to just let the settlement go rather than letting the HMO which I have been paying for for years recoup any of their expenses even if it means I will be bankrupt a few months earlier than I would be if I accept the offer. Any comments or advice that could change my situation?
    This is interesting because they offered me a 50% settlement of my total medical bill which was $105,000.

    But my friends insurance issued a check to me with the HMO as co-payee and I cashed it and the money has now been moved into another location.
    I have been receiving calls from a collection agency lately, but I doubt they have dealt with too many people like me.
    Heck, due to my hearing disability I can't even talk to them over the phone because they keep having someone call that English is a second language for and I have plenty of trouble trying to understand someone who calls that has no accent.
    I have no credit history, none what so ever, because I have always paid cash for everything and have never had a credit card.
    I don't believe in borrowing money.
    So without a court order to garnish my disability payments I don't see what they can do. Maybe ruin my credit?

  10. #10
    Join Date
    May 2007
    Posts
    6

    Default Re: Policy Limits and HMO Liens in California

    Sorry that was not the quote I was trying to use

    1. Sponsored Links
       

Page 1 of 2 1 2 LastLast

Similar Threads

  1. Traffic Accidents: My Insurance Co. Said I May Be Sued Beyond Policy Limits
    By rymfire4 in forum Accidents and Injuries
    Replies: 14
    Last Post: 07-19-2010, 07:12 AM
  2. Auto Insurance: California Car Accident Exceed Policy Limits
    By thewatcher101 in forum Insurance Law
    Replies: 9
    Last Post: 08-18-2009, 10:37 AM
  3. Traffic Accidents: Policy Limits
    By dasrock in forum Accidents and Injuries
    Replies: 1
    Last Post: 12-19-2008, 04:54 AM
  4. Traffic Accidents: Liabilty In Excess of Policy Limits in California
    By heatherseven in forum Accidents and Injuries
    Replies: 1
    Last Post: 09-06-2007, 10:32 AM
  5. Traffic Accidents: Policy limits less than costs of injury
    By peachy in forum Accidents and Injuries
    Replies: 5
    Last Post: 03-06-2006, 09:41 AM
 
 
Sponsored Links

Legal Help, Information and Resources