Personal Injury Settlements & Medicare

Serious injuries often necessitate immediate medical attention, surgical procedures, and rehabilitative services. As a Medicare recipient, you’re likely retired or have a preexisting disability that prevents you from holding gainful employment. As your medical bills start piling up, you may start wondering who you can turn to for immediate financial assistance. Fortunately, Medicare will cover any medical expenses related to your personal injury claim. However, there are certain rules and procedures you must follow if you want to benefit from this program.

Reporting Your Accident Claim

Before you can receive benefits, you must first report the accident to the Coordination of Benefits (COB) Contractor. According to the Centers for Medicare & Medicaid Services, “The Coordination of Benefits (COB) Contractor consolidates the activities that support the collection, management, and reporting of other insurance coverage for Medicare beneficiaries. The purposes of the COB program are to identify the health benefits available to a Medicare beneficiary and to coordinate the payment process to prevent mistaken payment of Medicare benefits.”

The Medicare COB Contractor will collect the following information:

  • Details about your case
  • Specifics about your injury
  • Your healthcare providers
  • The name of your attorney

Once your accident is reported, Medicare will officially start monitoring your case. The Medicare COB Contractor will regularly request updates from both you and your legal representative to ensure your continuing eligibility.

Settling Your Case

Your legal representative needs to notify the Medicare COB Contractor the moment your case is settled. The Medicare COB Contractor will send your lawyer a statement listing the medical bills Medicare has covered throughout the duration of your case. It’s important that these steps are completed before you receive any of the settlement proceeds. Once you’ve reviewed and approved Medicare’s statement, your lawyer will send the Contractor a check for the statement amount.

However, you need to notify your attorney immediately if you believe the statement includes expenses unassociated with your personal injury case. Your lawyer can contact the Medicare COB Contractor and discuss the dispute on your behalf. Unfortunately, this isn’t a quick process; in fact, it can take the Medicare COB Contractor months to reply to your attorney. If everything goes well, the Medicare COB Contractor will send a revised statement as soon as possible.

Alternatively, if the Medicare COB Contractor challenges your assertion, then you need to discuss your legal options with your attorney. Your simplest option is to pay the Medicare COB Contractor in order to settle the case. To legally appeal the statement, you lawyer needs to start the Medicare internal appeals process. It’s important to note that you can’t receive your settlement until the appeals process is complete. Depending on your individual case, your attorney will send the disputed amount to the Medicare COB Contractor or hold it in escrow.

Explore Your Legal Options with An Experienced Personal Injury Attorney

If you’ve been injured due to the negligent actions or inactions of a person, corporation, or government entity, contact the Montana personal injury lawyers at Odegaard Miller Law, PLLC. Our trial-tested legal team has the experience and resources to effectively represent your interests both in and out of court. With our help, you can secure a positive case outcome that safeguards your financial recovery.

We have 30+ years of experience. Contact Odegaard Miller Law, PLLC at (406) 640-4441 to schedule a free consultation. We serve the entire state of Montana from our offices in Billings and Helena.