Right of subrogation

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  • (a) Third-party coverage for medical care shall be primary coverage and shall be exhausted before any payment authorized under this chapter shall be made on behalf of any person eligible for services under this chapter.

  • (b) An applicant or recipient upon admission shall inform the Department of Health of any rights he has to third-party payments for medical care. The Department shall automatically be subrogated to any rights the recipient has to third-party payments and shall recover to the fullest extent possible the amount of all medical care payments or services made on behalf of the recipient. Recovery of such payments or services shall be collected directly from:

    • (1) Any third party liable to make a medical care payment to the provider of recipient's medical care or to the recipient under the terms of any contract, settlement or award;

    • (2) The recipient, if he has received third-party payment for medical care provided to him; or

    • (3) The provider of the recipient's medical care if third-party payment for medical care has been recovered by the provider.

  • (c) An applicant or recipient who receives medical care for which the Department may be obligated to pay shall be deemed to have made an assignment to the Department of any rights such person has to any payments for such medical care from a third party, up to the amount of medical assistance paid or provided by the Department.

  • (d) An applicant or recipient who receives medical care provided or paid for by the Department shall be deemed to have provided the Department the authority to release medical information with respect to such medical care for the sole purpose of obtaining reimbursement for medical care from third parties.

  • (e) The Department shall, in order to enforce its subrogation rights under this section, institute, intervene in, or join any legal proceedings against any third party, including the estate of a person who received medical care from the Department, against whom recovery rights arise. No action taken by the Department shall operate to deny the recipient's recovery for that portion of his damages not subrogated to the Department, and no action of the recipient shall prejudice the subrogation rights of the Department. The applicant or recipient or his beneficiary may not institute any action, or compromise any right of action he may have against a third party responsible for payment of medical care unless the Commissioner of the Department is a party to the action or agrees to the compromise. No compromise between the applicant or recipient, or his beneficiary and the third party responsible for payments of medical care shall be valid in law unless the expenses incurred by the Department in the case are first paid. No judgment shall be so entered in actions of this nature and no compromise as to the right of the parties shall be approved, without making express reservation of the rights of the Health Revolving Fund. The Clerk of the Court taking cognizance of any claim of the above-described nature shall notify the Commissioner of any order entered in the case, as well as the final disposition thereof.

  • The Commissioner may compromise as to the Department's rights against a third party responsible for the payment of medical care. Any sum obtained by the Commissioner under this section shall be covered into the Health Revolving Fund.
  • (f) When the Department provides, pays for, or becomes liable for medical care, it shall have a lien for the amount of medical care paid or provided upon any and all causes of action which accrue to the person to whom care was furnished, or to his legal representatives, as a result of sickness, injury, disease, disability or death, due to the liability of a third party which necessitated the medical care. The Department shall have one (1) year from the date when the last item of medical care relative to a specific accident or spell of illness was paid or provided in which to file its verified lien statement, and the statements shall be filed with the Clerk of the Superior Court, in the judicial district where the recipient resides or the medical care was provided. The verified lien statement shall contain the name and address of the person to whom medical care was provided; the date of injury; the name and address of the vendor or vendors providing medical care; the dates of service; the amount claimed to be due for the care, and to the best knowledge of the Department, the names and addresses of all persons, firms, or corporations claimed to be liable for damages arising from the injuries.

  • (g) In recovering any payments in accordance with this subsection, the Department is authorized to make appropriate settlements.


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