I’ve got a settlement and an 18 y/o client whose mother works for the federal government. All the medical bills appear to have been paid by the mother’s private insurance company, but I suppose that they may be the administrator. This is an Anti Subrogation state, but we assume that FEHBA plans are preempted. We have received no notice from the FEHBA or Private Insurer plans about any sort of subrogation interest. Have you been down this road before? – Confused in the Carolinas
In reviewing FEHBA subrogation, it generally preempts state law and is not beholden to ERISA law in which North Carolina is an Anti Subrogation state for some insured plans. I’ve been looking for any type of loophole where NC’s anti subrogation can be can be argued for a FEHB plan, but everything I’ve found is to the contrary. The strength of the right of recovery in a FEHBA plan lies in the specific description within the plan. I looked through a few plans to get an idea on how NC FEHBA plans are written. Specifically, I reviewed the BCBS of NC FEHBA Standard and Basic Operation plan for 2009 to get an idea of what the plan language may look like in this situation. According to the 2009 plan, it is the responsibility of the beneficiary to notify BCBS of any claim made against another party for compensation of an illness or injury where BCBS has made payment. According to their plan language, they are entitled to full recovery, and not subject to reduction for procurement. However it does express a willingness to grant a reduction at their discretion. It was not specified if the incident occurred in 2009, you would need to review the plan document for that year of enrollment. Hope this helps! Have a lien question? Ask us! Send your question to firstname.lastname@example.org.