Visitor Question

Is defendant’s car insurance company entitled to the amount Medicaid paid?

Submitted By: Matty (Akron, Ohio)

I was the passenger in a car driven by a negligent driver who drove headfirst into a tree. I suffered a broken pelvis, a broken left foot, and multiple fractured ribs. The driver’s insurance company has admitted fault and we are in the process of settling. I have submitted to them all of my medical bills that’s are well over $35,000.

My issue is that Medicaid paid a majority of these bills but at a much-discounted rate. Is the defendant’s insurance company entitled to know how much was actually paid or are they liable for the full amount of the bill provided by the medical provider?

They are trying to get me to sign a release so that they can find out how much Medicaid actually paid on these bills. Is that a normal thing and should I sign that release for them to find out that information or would that cost me, in the long run, a better settlement?

I live in Ohio. I am finally over my injuries and the accident was back on May 19th 2020. So my question is, they’ve seen all the bills from the medical providers but now they’re asking me to sign a release giving them permission to find out how much my insurance company Medicaid paid on these bills.

I understand Medicaid needs to be reimbursed and I’ve been in contact with them but shouldn’t it be my responsibility to pay them out of my settlement?

Please help!

Disclaimer: Our response is not formal legal advice and does not create an attorney-client relationship. It is generic legal information based on the very limited information provided. Do not rely upon the information in our response, or anywhere else on this site, when deciding the proper course of a legal matter. Always get a personalized case review from a local attorney.

Answer

Dear Matty,

The defendant’s insurance company has to pay you for the full amount of the bills provided by your medical providers. Provided that you haven’t settled your claim yet, the amount that Medicaid paid shouldn’t concern the insurance company.

Compensation from the Defendant’s Insurance Company

If someone was injured by a negligent driver, the victim can file an injury claim with the driver’s insurance company.

The company then has to compensate you for such losses as:

  • Medical expenses
  • Lost wages
  • Future lost earnings
  • Property damage
  • Out-of-pocket expenses
  • Pain and suffering

When it comes to medical expenses, an insurer has to pay you for the full amount of these expenses. It can’t pay you at a discounted rate.

Your email mentions that you’ve fully recovered from your accident. But if you anticipate needing future medical care because of the accident, the insurer should compensate you for the full amount of that expense as well.

Medicaid’s Reimbursement

As you correctly point out in your message, Medicaid is entitled to reimbursement for the money it paid on your behalf.

The same rule is set forth in Section 5160.37 of the Ohio Revised Code.

Medicaid typically notifies settlement beneficiaries of any liens after a settlement is final. But keep in mind that Medicaid has up to six years to notify you of a lien. So you may not hear from them for some time.

Once you do, you may want to contact an attorney for help. Lawyers can sometimes negotiate liens and help get them reduced.

Signing the Release Form

Claimants must always cautiously approach any type of release form that an insurer provides. This is especially true when unrepresented by an attorney.

Here, since the insurer has to pay the full amount of your medical expenses, the amount Medicaid paid is largely irrelevant. We recommend holding off on signing the release form.

However, since we don’t have access to the specific language of the form, we recommend you speak with a local attorney for help. An attorney can contact the insurer on your behalf and inform them that it isn’t in your best interests to sign a release.

Learn more here: Negotiating Medical Liens

The above is general information. Laws change frequently, and across jurisdictions. You should get a personalized case evaluation from a licensed attorney.

Find a local attorney to give you a free case review here, or call 888-972-0892.

We wish you the best with your claim,

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