Med Pay Reimbursement

Every state is different. But, when it comes to med pay, if you have a reimbursement provision subject to the made whole doctrine (or make whole doctrine, depending on your state), you have an interesting argument with MIST cases.

The insurance companies take the position that these cases have no value and that people are not hurt. So, if the bills are paid by med pay, you can turn around and use two arguments against the first party insurance company that is seeking reimbursement.

Option A: If you have an insurer who argues on these cases, and you will know this by keeping the spreadsheet discussed in the book, then you can argue that if no one is hurt, then they should not have paid the medical bills. If the bills are not reasonable and necessary because no one is hurt, you don't owe them any money. Simple enough.

Option B: You argue that your client was not made whole. When the client is not made whole, the insurer should not recover any money. There are a variety of cases on point, but see Chong v. State Farm in California. And if you can get a copy of it, my article on Forum Magazine from CAOC that provides cites to other cases in other states. (I am working on a getting a copy on the website.)  You then argue that the client was not made whole since the third party insurer did not offer full value of the case due to the "amount of damage."

These two tricks should help you when you can use the made whole doctrine.

UPDATE: You can get my article by clicking here: Download 0703-pg31-stein.pdf

Comments

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I have a friend that had the a similar situation but they couldn't solve him anything because they told him that he made the tramit long time after the problem so the insurance company told him that it didn't have any value.

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the bills are paid by med pay, you can turn around and use two arguments against the first party insurance company that is seeking reimbursement.

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those two tricks are amazing because sometime the insurance doesn't cover all the damages, and with those arguments now we can defend our self

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