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.
Posted on Mon, July 2, 2012
by Sharon Coleman filed under