I just assisted an older adult with a slip and fall. This gentleman is 80 years old and tripped in a local grocery store. This had nothing to do with any balance issues, it everything to do with a mat that was protruding from the floor. This significance to the aging world is this: now due to the growing Medicare shortfall in Washington liability insurers (which include carriers who write CGL policies, auto policies, homeowners’ policies and those defendants who are self-insured such as supermarkets) are required to determine and report whether a claimant is covered and is entitled to Medicare benefits. If the claimant received Medicare benefits during their treatment for the injury, Medicare is and will be relentless in its pursuit of a 100% reimbursement.
This new law will pose new challenges for plaintiff’s attorney and the plaintiff. If the attorney or insurance carrier does not comply, they risk being sued by the Government for reimbursement up to five years post-closure and monetary fines. If there is a settlement and Medicare does not know about it and mistakenly pays for services it has a right to recover, it can go after the attorneys whose fees are paid out of the settlement.
Also the Medicare recipient can lose his or her benefits. Lawyers could be exposed to malpractice claims for not handling a client’s benefits properly. Insurers can be liable for monetary fines for failure to report. If a plaintiff loses his Medicare benefits, the plaintiff may bring a legal malpractice claim against the attorney and a bad faith claim against the insurer for not making sure Medicare benefits were protected.
This is bad for older adults because there is and will be less of an incentive to assist older adults with their legitimate personal injury claims. A settlement amount will have to cover Medicare charges up to 100%, attorney fees and provide money for the plaintiff. If that type of recovery does not seem likely, most attorneys will strongly consider rejecting the case.
Finally, negotiations with the liability insurance carrier will become more difficult. They will demand information about your client, such as social security number, so that they can comply with the requirements and avoid fines. Once the claim is settled, it can take up to four months before Medicare signs off on the settlement.
