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How Does Medicare Fit Into Your Personal Injury Case?

Posted by Guy DiMartino | Jan 13, 2013 | 0 Comments

Florida medical malpractice and injury lawyer discusses Medicare issues.

The baby boomers are reaching 65 or Medicare age very rapidly.  Many people who come into my office after an accidental injury have Medicare.  The question always comes up – will Medicare pay my doctor and hospital bills for my accident.  The answer is yes – if a few conditions are met.

Medicare Payment Is Secondary

Medicare coverage is not primary in an accident case – it is secondary.  That means that all other medical coverage available must be used up before Medicare will pay.  For instance, if you are involved in a Florida car accident, your personal injury protection “PIP” coverage must be used up before Medicare will kick in and make payments.

If you were injured in a slip and fall on a residential or commercial property, you have to first check and see if the property owner or renter has a medical payments provision in their policy before Medicare will kick in.

Medicare Has a Right of Reimbursement

The payments made by Medicare are considered conditional payments and are subject to the Medicare Secondary Payer Act.  Under this provision, Medicare is entitled to reimbursement at the end of the case if monies are received from the at fault party. If no monies are received, Medicare is not entitled to reimbursement.

Medicare is Slow

When Medicare is involved in your case, it slows down the case considerably.  It takes weeks and months to get payment records from Medicare.  Many times the initial payment records are wrong and list charges that are not related to the client's injuries.  When this happens, we have to send written notification to Medicare and it will respond in 3 months or so.  Often, we have to go through this process multiple times to get the Medicare payment ledger correct.

Insurance companies are very scared of Medicare liability so they will not finalize a client's case until the Medicare issues are resolved and we receive a final demand amount of from Medicare.  This process has a tendency to delay disbursement of funds once the case is settled.

The recent Medicare changes makes injury and accident law more complex, if you have any questions about a Florida injury and accident case, call Guy S. DiMartino, DC, JD at (352) 267-9168 or fill out the internet consultation form on the right hand side of the screen.

About the Author

Guy DiMartino

I have loved helping people in need for almost three decades.  It has been my privilege to serve people as their pastor, chiropractor, and lawyer.  The current focus of my legal practice and lifes passion is helping the seriously injured receive complete compensation for their injuries. I am a ...

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