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Everything listed under: medpay

  • Medpay and Title 12 Sec 3009.1

    MVA client has medpay which paid her medical bills. Liability adjuster contact the providers and verifies that all bills were paid by medpay. Adjuster now maintains he does not have to consider the bills per 12 O.S. section 3009.1.

    Answer: I sure don't think so. If Med-pay paid the bills, it paid the face amount of the bills. For that reason, even if the statute applies and is constitutional, the "actual amounts paid" will be the amount billed and which Med-pay paid. Then there may or may not be subrogation for those bills, depending on whether the client is a named insured or household member or a permissive occupant. I think they are just not thinking this through. Incidentally, is your case one arising from a wreck before or after 11/1/12. If the wreck was before that date, the statute clearly does not apply.

  • Healthcare Liens

    Do health care liens attach to medpay benefits? What aboutsubrogation claims by an ERISA plan?

    Answer: Hospital liens don't attach to medpay but others do. See:42 O.S. §46 Physician's Lien: contains subsection B that, in addition to lien provided in subA, physician shall have lien "against an insurer." 42 O.S. §43. Hospital Liens, has no such provision and, therefore, arguably does not attach a lien to UM or med-pay.
    Ambulance lien 42 O.S. § 49 is worded like § 46. 63 O.S. §5051.1 A2 Payment by OHCFA for one with a claim "against an insurer," creates a debt to DHS.Kratz v. Kratz, 1995 OK 63, 905 P.2d 753: Hospital lien does not attach to UM coverage.Broadway Clinic v. Liberty Mut. Ins. Co., 2006 OK 29, 139 P.3d 873: Physician's lien attaches to UM.

    As for the ERISA subrogation,Generally they have a claim against the medpay recovery. However, it depends on the language of the ERISA plan. The two contrasting cases on that areProvident Life & Accid. Ins. Co. v. Ridenour, 1992 OK CIV APP 93, 838 P.2d 530 (Health insurance company not entitled to subrogation against UM). Distinguished byReeds v. Honorable Thomas S. Walker/NAICO v. Reeds,2006 OK 43, 157 P.3d 100.

    Personally, I am unable to distinguish the policy language in Ridenour from that in Walker but inRidenour, the Court of Civil Appeals held there was no subrogation where the ERISA plan provided subrogation for claims against "third parties." That did not reach subrogation against UM coverage but reached only claims against the tortfeasor. The Supreme Court inWalkerfound a very similar provision providing subrogation against a "third party" applied to the insured's own UM coverage since the UM carrier was a "third party" to the transaction between the ERISA insurance company and the injured insured. It appears to me the Supreme Court just didn't want to reverse Ridenour. I would expect the same rules would apply to medpay coverage.