It’s been more than a month since the federal government shutdown began. While many essential services are experiencing disruptions, there are crucial programs, such as SNAP benefits, that are causing Americans to face serious struggles at a time when numerous economic challenges already exist. And yet, there has been little progress, if any, towards reopening the government.
As Virginia personal injury lawyers, we know there are concerns about how the shutdown could impact claims. A key issue is the effect it has on TRICARE and Medicare liens.
The most important thing to know is that these liens are delayed, not eliminated. But it’s also important to understand how TRICARE and Medicare liens work, and that delays or interruptions like the shutdown affect personal injury case resolution and lien negotiations.
What is a Medicare or TRICARE Lien?
If someone is injured and Medicare or TRICARE paid for medical treatment, Medicare and Tricare are entitled to recover the amount they paid if the injured party obtains a judgment or settlement from a personal injury claim. Recouping medical fees they covered is referred to as a TRICARE lien or Medicare lien, and there are strict processes that must be followed to reimburse them.
Liens ensure that federal medical programs are reimbursed when another party is held responsible for paying someone’s medical fees. The other party is considered the primary payor, and could be the person who caused the injury, their insurer, or workers’ compensation benefits. In these cases, TRICARE and Medicare are secondary payors.
For example, if you’re injured in a Virginia car accident and the other driver was found to be fully at fault through a personal injury claim, that driver’s insurance company is responsible for paying your medical bills and property damages. If Medicare or TRICARE initially covered your medical treatment, they’ll place a lien on your settlement to get back what they paid.
Can a Medicare Lien or TRICARE Lien Be Negotiated During the Shutdown?
Personal injury victims should be prepared for some delays with Medicare and TRICARE processing and customer support during the government shutdown, including negotiations. But negotiating a lien is an important step when a personal injury case settles. Why? There’s a specific process for how personal injury settlements are paid out, which includes paying Medicare liens and TRICARE liens first – before funds are disbursed to the victim. An attorney experienced in Medicare or TRICARE liens will get the best outcome in negotiations. In terms of liens being waived, it’s extremely rare, but it happens sometimes.
How the Shutdown Affects Resolving Personal Injury Claims
The government may not be fully operational, but Medicare and TRICARE lien rights still exist. While personal injury cases already take significant time to resolve, the shutdown is expected to cause some hiccups.
There are a few ways a personal injury claim may be affected during the government shutdown:
- There will be operational slowdowns and delays because both TRICARE and Medicare are federal programs.
- A backlog is possible once the government reopens.
- Your attorney may need to estimate lien amounts or hold funds from the settlement in trust until the exact amount is confirmed.
In addition, if negotiations or getting the lien amount are delayed because of the shutdown, your personal injury case cannot be fully resolved; you may be awarded a settlement, but it cannot be fully disbursed until after the lien is paid. In such situations, a sufficient amount of money will be held in the lawyer’s trust account at the time of disbursement to the client to cover the anticipated TRICARE and Medicare liens.
Compliance with Medicare and TRICARE is crucial, and failing to comply puts you at risk of severe penalties. An attorney can walk you through the process and negotiate on your behalf to secure the compensation you deserve.
At Curcio Law, we’re committed to managing the challenges of the government shutdown and its effect on our clients’ cases. If you have any questions or concerns about your case or a lien, or if you were injured and someone else may be liable, contact our firm online or call/text (703) 836-3366.
Lien FAQs
Who Handles Lien Processing for Medicare and TRICARE?
The Defense Health Agency and its contractors handle TRICARE lien processing. The responsibility of handling Medicare lien processing falls on the Centers for Medicare and Medicaid (CMS), a part of the Department of Health and Human Services.
How Lien Amounts are Determined
Once Medicare or TRICARE is notified of a personal injury settlement, they’ll provide a breakdown of services and treatment they paid for that need to be reimbursed. Reviewing this information is a crucial step and should involve the help of an attorney. These programs are only allowed to recover medical costs they paid for if a personal injury settlement or judgment is obtained, which includes compensation for medical expenses.
TRICARE and Medicare Reporting Requirements
Personal injury cases that involve Medicare payments must be reported to the Benefits Coordination & Recovery Center. Failing to report to the BCRC can lead to serious penalties.
For TRICARE, if they receive a claim that they deem may involve third-party liability, they’ll send a form to the claimant to complete. Once submitted, it will be used to determine what happened and whether someone else is responsible for paying for the medical treatment a beneficiary received. While TRICARE will automatically send the third-party liability form when certain codes for medical care are used, you should always notify them if you’re pursuing a personal injury claim.
