Harry Stump, Esq.

Category: Subrogation

  • CAR ACCIDENTS, HEART & LUNG BENEFITS AND SUBROGATION

    This office ended the unjust subrogation of Heart and Lung  from police officers and other public safety personnel involved in Pennsylvania auto accidents.  In 1993, when Workers’ Compensation benefits were again subjected to subrogation in auto accident cases, governments began to claim subrogation rights from Heart & Lung benefits paid to public safety personnel.

    Heart and Lung Act benefits were created by the Legislature to provide full payment of salary to police officers, firemen and other law enforcement officers who are injured in the performance of their duties and by reason thereof are temporarily incapacitated from performing their duties.  These benefits are different from Workers’ Compensation benefits.

    Based upon a statutory construction argument, this office was able to convince the City of Pittsburgh to waive Heart and Lung subrogation in car accident cases.  When the City of Pittsburgh changed its position and attempted to collect this subrogation, this office filed a Declaratory Judgment lawsuit against the City of Pittsburgh.  Despite the fact that the Commonwealth Court had already ruled against public safety workers on this same issue in Brown v. Rosenberger, 723 A.2d 745 (Pa.Cmwlth. 1999), Allegheny County Common Pleas Judge W. Terrence O’Brien took the unusual step of disagreeing with controlling appellate authority and ruled in our favor.

    The City of Pittsburgh appealed to the Commonwealth Court, which convened a Court en banc, consisting of seven judges.  The Commonwealth Court ruled 6-1 against our position.  Judge Doris Smith-Ribner wrote a vigorous dissenting opinion in Oliver v. City of Pittsburgh, 977 A.2d 1232 (Pa.Cmwlth.  2009)

    This office appealed to the Pennsylvania Supreme Court, which unanimously reversed the Commonwealth Court opinion and ruled in favor of the public safety workers in Oliver v. City of Pittsburgh, 11 A.3d 960 (Pa 2011). This case is the basis for the elimination of the unjustified taking of personal injury settlement money from a long list of law enforcement personnel including: city, county, local and state police; LCB enforcement officers or investigators; parole agents; drug enforcement officers; park guards, firemen; deputy sheriffs; Game Commission and Fish and Boat Commission enforcement officers or investigators; and many additional state, local and county law enforcement.

    This is important because these liens can be large compared to the third party liability insurance available in many cases.  Pennsylvania’s minimum auto liability insurance limits of $15,000-$30,000 have not been raised since the last century, while medical costs have skyrocketed.  Many injured public safety worker occupy motor vehicles not covered by underinsured motorist coverage.  An injured person could be left without a remedy for their injuries after paying subrogation costs.  It is time for the Pennsylvania Legislature to end subrogation for Workers’ Compensation benefits in auto accidents.

  • ACCIDENT RELATED SUBROGATION- HOW TO MINIMIZE IT

    In Pennsylvania, accident related medical bills, other than car accidents covered by first party benefits, will be paid by your own health insurance.  If you have Medicare, Medicaid, Workers’ Compensation, Veterans Administration benefits, an HMO or any other private health insurance plan, there will almost always be subrogation claims in the event of a settlement.  Non-ERISA health plans may be barred from subrogation in Pennsylvania car accident cases.

    There are a number of legal and medical issues that can be raised in order to try to reduce the subrogation lien.   The legal issues require the collection and review of the underlying documents of the client’s health care plan.  Health care plans differ in the language they use and it must be determined if they are legally entitled to claim what they have claimed.

    A recent legal issue involved the collection of Heart & Lung Act benefits in motor vehicle accidents.  This office filed a Declaratory Judgment action that went to the Pennsylvania Supreme Court which ruled that Heart and Lung Act benefits were not subject to subrogation in car accidents.

    The medical issues require research of the client’s medical history.  Not every medical bill is related to the accident in question.

    Producing evidence of hardship on the part of the client may serve to reduce or even eliminate a substantial subrogation claim.

    In many cases, this office has secured substantial reductions or waivers of subrogation claims for the benefit of the client.

  • SUBROGATION & ACCIDENT SETTLEMENTS

    In Pennsylvania, if you are injured in an accident and receive a settlement, there may be a legal duty to repay the health insurer who has already paid your medical bills.  This is referred to as subrogation.

    Subrogation arises out of various laws such as Medicare, Medicaid, Workers’ Compensation, and Veterans Administration heath care.

    Subrogation also arises out of the private health care insurance contract that paid your hospital and medical bills.  Typical language found in a health care booklet states that:  “The Plan also has the right to seek payment and/or reimbursement from you if you receive a payment, settlement, judgment or award from a person, organization, or insurance company in connection with an injury caused or alleged to be caused by the person or organization.”

    Some private health care insurance plans may demand repayment of their entire lien, even if it takes your entire settlement.