I have a case that has a private insurance lien. I sent in a notice to the insurer, but got a response from another company. What do I do with this? When resolving a possible lien with a private insurer, it is important to know who the involved parties are, and their role in the resolution of a case. You have received a response from a “Recovery Contractor” which is a separate company hired by the insurer to address all subrogation and recovery issues on their behalf. Recovery contractors have the authority to initiate collection activity against the insured, to provide information about the claims included in the lien, and act as the liaison between the lien holder and the insured in matters of lien negotiation. In order to get the best results from a recovery contractor, there are three things you should know.
1. They want to recover as much as possible – even if they aren’t entitled to it!
Recovery contractors are a lot like collection agencies. They want to recover as much as possible, because in some cases, it adds to their bottom line. The problem with that is, the amount that is submitted for payment is not always the amount that the claimant should have to pay. It is important to audit the claims included in the lien to be sure that they are all related to the compensable injury. Even more important is the evaluation of the plan language and plan type before making any offers or payments.
2. Sometimes they lie.
It is a bad thing, but it happens. Recovery contractors will sometimes stretch the truth in order to get the amount that they want. For example: If a plan is an insured employee health care plan with weak subrogation language, a recovery contractor may tell you that it is a self-funded ERISA plan with a stronger right of recovery, in hopes that an uninformed attorney or professional will pay the lien at face value. In many cases it works, and a payment is made out of ignorance that affects the net settlement to the client. It is imperative that the necessary research is done in order to avoid this pitfall. Request the Specific Plan Description to see what the plan is entitled to. Then request the Form 5500 to determine what type of plan it is, insured or self-funded. Once you have that information, you will be able to make a better decision before resolving the lien.
3. Get it in writing!
Synergy has developed resolution programs that address ERISA, FEHBA, Private Insurance, and Provider/Hospital liens. We have a proven record of success, let us help you get the best results on behalf of your client. For more information, contact Synergy at (877)907-LIEN (5436) and speak to one of our associates today!