The Affordable Care Act (ACA) continues to make headlines as Oregon struggles to roll out its online enrollment portal. Several million dollars later, the State of Oregon decided to adopt the federal website portal, making it the butt of many jokes. This article discusses how the ACA may affect Oregonians pursuing personal injury matters.
When somebody is severely injured in a motor vehicle collision, they may have personal injury protection benefits that pay medical expenses incurred within the first year of the collision. In Oregon, this coverage is required, but in Washington, it is optional. In either case, the personal injury protection benefits provide medical coverage, but only up to a certain amount, and only for a limited time. We have worked on cases where the PIP coverage is gone by the time our client arrives at a trauma center.
If someone injured in a car or truck collison has employer sponsored health care, it takes over payment medical expenses where the PIP ends. However, when the personal injury case resolves, the health plan will seek reimbursement of the benefits it paid from any settlement or verdict. This can be a significant problem where the health plan pays an amount pays significant benefits approaching the settlement recovery.
In the past ten years, the United States Supreme Court has interpreted the federal statute governing employer sponsored health care plans to give the people who write these health plans overwhelming power to recover every penny of an injured party’s recovery, regardless of the equity or fairness involved.
Under the ACA, however, many health plans will not be employer sponsored, but individual plans, and therefore, will not be subject to the current system allowing employer sponsored health plans to take every penny of a settlement. Because the ACA does not contain any specific subrogation provisions, it is possible that state, not federal law, will govern how much a health plan can recover from an injured person's settlement or verdict. This is good news, because many states have laws that look at the bigger picture in determining how much a health plan can take back from a settlement.
If you are involved in a significant injury claim in Oregon or Washington, and wonder whether your health plan will seek a part of your injury settlement, the injury settlement or recovery, call us at 503-325-8600. We are tracking this new legislation, and can share our knowledge.