Role Of Medicare In Personal Injury Litigation

If you are injured in an automobile accident, you are likely to have car insurance to cover your medical expenses.  For other types of accidents, your health insurance coverage may pay those bills, particularly if you are using in network providers.

Some accident victims may be enrolled in Medicare which will be the primary source of payment for their medical expenses.  Typically the hospital or other treatment facility will record the patient’s Medicare information and would be likely to bill any unpaid expenses to Medicare.

To the extent that Medicare pays those bills, it will seek reimbursement from your recovery in your accident case.  This should be contrasted with personal injury protection benefits paid by an auto insurance company for which reimbursement is not sought.  For medical expenses paid by your health insurance carrier, the terms of your policy may or may not entitle the carrier to seek reimbursement from your recovery.

When a personal injury case is resolved and payment is received, the attorney for a Medicare enrollee client is obligated to contact Medicare in order to determine whether Medicare will seek reimbursement of payments.  This requires written notice and the client’s authorization.  In months or weeks, Medicare will respond as to what must be reimbursed from the client’s share of the recovery.  Any attorney failing to follow this procedure may become liable to Medicare.

In cases where a Medicare enrollee is an uninsured pedestrian, it is possible to apply to the New Jersey Property Liability Insurance Guaranty Association for payment of medical bills.  It is preferable to have the bills paid by PLIGA which does not seek reimbursement, than having the bills paid by Medicare, which does require reimbursement in most cases.  For more information on PLIGA, please see our July 2015 blog “What is PLIGA and What Can it Do For Me?” at

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