January, 2018, a covered member of one of our client’s self-funded ERISA benefit Plans was severely injured in a single motor vehicle accident which resulted in $274,000 in medical bills. Upon contacting the member’s auto insurance carrier, we learned that health providers had been paid by both the plan the insurance carrier. The accident occurred in a no-fault state and personal injury protection (PIP) benefits were available.
Because we had recommended a change in plan language, our client’s language now contained a Coordination of Benefits provision which made the health plan secondary to No-fault benefits. The member’s Auto Insurance carrier should have been the primary payor on all medical bills. Many providers had collected from both plans.
This case was immediately referred to an attorney who guided a paralegal in the overpayment process. Refunds were sought from overpaid providers. With the patient still receiving treatment, the paralegal was also able to contact the Plan to cease future payments while putting the Auto Insurance carrier in the rightful designation as sole primary payor.
Had our medical subrogation reimbursement specialist team not caught this, it would’ve cost our client well over $274,000. This is the type of service and attention to detail the medical subrogation unit provides on a daily basis. Without any legal representation outside of the Vengroff Williams’s attorneys, without a lawsuit or any personal injury or insurance litigation, the reimbursement subrogation unit was able to recover $274,000 for our client within three months from the date of our demand letters.