From the Listserve (Continued from page 30)
pursue recovery of our lien.” I trust more than a few of you have dealt with this matter and I would appreciate any guid- ance concerning how to forestall action by MAMSI and, if possible, compromise its lien to maximize my client’s eventual recovery. Thanks in advance.
From: “Rodney M. Gaston”
gastonlaw@smart.net O.K..Here are my two cents on the MAMSI/M.D.IPA lien issue. First: Re- quest a copy of the policy that contains the subrogation clause. The paragraph that I was provided by MAMSI/M.D.IPA reads as follows:
“ACTS OF THIRD
PARTIES” If a member is injured or be- comes ill through the act or omission of a third party, M.D.IPA shall provide the benefits described in this EOC. How- ever, with respect to such benefits, if the injured or ill Member is entitled to re- covery from such injury or illness from any third party, such Member must com- ply with the following: 1. If the member receives payment from a third party for medical expenses, regardless of whether the Member has been fully compensated, whether by reasonable cash value of any benefit or service received from M./ D.IPA, the Member shall reimburse M.D.IPA up to the reasonable cash value for the services and benefits covered by M.D.IPA . Such reimbursement must be made immediately upon collection of damages by the Member, but shall be net of reasonable attorneys fees sustained and court costs by the Member prorated to reflect that portion of the member’s total recovery which is due M.D.IPA. M.D.IPA
will not assume any litigation expenses. “The operative words above are medical expenses. MAMSI is only entitled to that portion of the recovery that represents payment for medical expenses. (Their lien letter applies to cash value of medical ben- efits PAID.) Second: The lien form that MAMSI/M.D.IPA always send out states:” LIEN AND ASSIGNMENT AND WAIVER OF STATUTE OF LIMITATIONS “The undersigned mem- ber who was injured in an accident that occurred on or about_________ hereby acknowledges and agrees to a lien against all proceeds from the above accident in favor of M.D.IPA for the cash value of medical benefits paid. Attached and made a part of this lien is the most recent MD/ IPA Medical Summary of Paid claims, evidencing the amount of the current lien. This Medical Summary of Paid Claims may be supplemented as additional medi- cal expenses are incurred by MD/IPA on behalf of the undersigned. The amount of MD/IPA’s lien is the amount of the most recent MD/IPA Medical Summary of Paid Claims, whether attached hereto at the time of receipt of proceeds or not. The undersigned hereby assigns to M.D.IPA said sum from the proceeds of a financial settlement or judicial award against the responsible third party. The statute of limitations is waived and ex- tended by the undersigned for the benefit of MD/IPA”DON’T LET YOUR CLI- ENT SIGN THIS DOCUMENT WITHOUT SOME IMPORTANTMODIFICATIONS!!! WATCH OUT! YOU CANNOT IG- NORE THIS DOCUMENT—IF YOU DO MAMSI WILL TAKE BACK ALL OF THE MONEY IT PAID OUT TO THE MEDICAL PROVIDERS AND YOUR CLIENT WILL BE PERSON-
Thomas C. Cardaro
PH: 410-752-6166 FX: 410-752-6013
ALLY RESPONSIBLE TO PAY THE DOCTOR. My two cents: MAMSI is NOT entitled to a lien on very single dol- lar you recover for your client. Their lien is limited by contract to monies you re- cover that represent reimbursement for medical expenses incurred. For that rea- son the words “all proceeds” which I highlighted above, should be stricken and replaced with the words “proceeds repre- senting reimbursement for medical expenses incurred and actually paid by MAMSI”. MAMSI is not entitled to any- thing more. You need to add to the last sentence the words:.. against the respon- sible third party that represent reimbursement for medical expenses in- curred by the member and paid by MAMSI. “In support of my changes to the lien letter, I send MAMSI a letter ex- plaining that all civil verdicts in the State Of Maryland are required by statute to be broken down to reflect payment for past medical expenses and of course pain and suffering. (See C.J.P. 11-109). In the event they jury does not award every past medical expense and awards your client medical expenses that are less than the expenses paid out by MAMSI (less your 1/3 Statutory deduction under C.J.P. 11- 112- Note: their initial letter always offers you only 25% reduction-but they have to agree to 1/3rd or retain their own attor- ney.) but a huge award for pain and suffering-you protect your client from MAMSI getting their hands on that part of the award- the part that they are not entitled to as a matter of law pursuant to the contract! This is the best way I know of to protect your client’s recovery from the impermissible language in the form LIEN LETTER. (The more interesting question is how do you differentiate in the out of court settlement, the amount of damages that represent past medical expenses, and those that represent other damages-especially if the past meds are high and the settlement is really low. It would appear somewhat difficult to claim in a settlement demand that all of your client’s medical expenses were necessary and then try to convince MAMSI latter, that the settlement represents only a por- tion of the claimed medical expenses and then try some hocus pocus on the settle- ment amount to reduce the amount you owe MAMSI, however, I will leave that topic for discussion up to Irwin, Charles, George and our President.)I hope I haven’t put everyone to sleep. If anyone has ad- ditional thoughts or suggestions please advise. Rod P.S., If MAMSI has changed it’s form letter please let me know.
34 Trial Reporter Spring 2003
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64