Irene Gabo Interviewed on the Davidzon Show on September 27, 2019
Does Medicare have to be paid back if they paid for my treatment resulting from an accident?
Yes, Medicare must be notified that there is a case pending and they will have the right to assert a lien on the recovery in your case. For example, if Medicare paid for your surgery resulting from the accident in the sum of $25,000.00 for a $50,000 bill from the hospital, they will present your attorney with a letter requesting $25,000.00 to be paid back. Your attorney must include that amount in his or her negotiations before the case is settled, so that amount will be covered in the settlement. Once the case is settled, the attorney will then notify Medicare of the settlement amount and they will send what is called a Final Demand, which will be a reduced amount, usually by 1/3.
Will I lose SSI and Medicaid benefits if I get money from a case?
This question is asked a lot by my older clients, and the short answer is no, if the money received from the settlement is spent correctly. To begin with, there are very few defendants who require that you contact Medicaid before the settlement check is issued, those are usually city agencies and bus and subway system. And for example you get a bill from Medicaid/SSI that has to be paid back. Either, you can spend the money you receive on necessities (such as medical treatment, household repairs, new appliances, pre paid funeral expenses, and many others) or you create a trust where you are allowed to receive a certain amount every month from the settlement that allows you to stay on Medicaid, and the rest stays in the trust. But please remember, the circumstances of Medicaid asserting a lien are rare, and can be dealt with by your attorney
Will Workers Compensation have to be paid back if I have a case?
In all cases, except where a grave injury is involved, the answer is yes. If WC paid for your medical treatment, your time out of work, or gave you an award, that amount gets totaled and becomes a lien against your case. This amount is important to know before your attorney settles the matter, because this has to be part of negotiations, as WC usually only reduce their lien by 1/3. So for example, if they paid out 90k, they’ll want back 60k from your settlement. In some cases, where proving the case is difficult and as a result the settlement offer is lower, your attorney may ask for what is called and equitable distribution, where you, your attorney and WC will each get 1/3 of the settlement.
What happens if I am on Section 8 housing?
I have never seen this happen, and my answer would be similar to my answer in #2. As long as the money is properly spent if SSI ever inquires about your income, or if there is a proper trust in place, you have nothing to worry about.
If the doctor doesn’t get paid for my knee surgery from a car accident, can he come after me?
When you started treating with the doctor, most like the doctor had you sign a form called Assignment of Benefits, meaning the doctor can bill the insurance company who is paying your bills for the car accident, directly. The form is helpful to you because it also means that if the doctor performed the surgery that the insurance company found to be medically not necessary and hence deny the bill, the doctor cannot come after you directly, as it was his medical decision to do the surgery. What the doctor will need to do is arbitrate the bill with the insurance company and if he loses, he won’t get paid.
However, he may go after you is if the denial of the bill was because your failed to show up for medical exams that the insurance company scheduled for you.