Legal Question in Insurance Law in Massachusetts

I had a replacement hip device break. Blue Cross and Medicare paid most of the bills. Now the device company want to settle because of the medical expences and the lost wage plus other expences. My question is will have to reimburse Blue Cross and Medicare with any of this settlement money.


Asked on 10/19/09, 5:27 pm

1 Answer from Attorneys

Roger Turgeon Turgeon & Associates

If you are talking about the medial expenses involved in replacing the failed prosthesis, your BC/BS policy almost certainly has language that gives the insurer subrogation rights in any recovery you get from the manufacturer. If BC/BS has sent you or your attorney a formal written "Notice of Lien" that follows the Mass. statutory requirements, your attorney will have no choice but to take care of that lien. If no such notice, your attorney doesn't have to resolve that lien before handing over the settlement proceeds to you, but you will still have that contractual obligation to repay the insurer.

If your BC/BS coverage comes as part of an ERISA plan, the calculus on all this can get complicated. Also, if your attorney deals with BC/BS before dispursing the settlement money, you may be able to negotiate with BC/BS to take less than they are asking for, in order to encourage you to settle with the manufacture (so they can get $$) rather than go to trial and risk no one geting anything.

There are lawyers handling multiple failed implant cases, and if you don't already have a lawyer, you should at least talk to one.

Roger Turgeon

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Answered on 10/24/09, 6:17 pm


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