Overview of MassHealth Liens on Massachusetts Personal Injury Cases and What to do About Them

In the vast majority of Massachusetts personal injury cases, liens are something that are often asserted and must be dealt with. There are many different types of liens (e.g., private medical providers’ liens, private health insurer’s liens, liens from government funded health plans) that the plaintiff’s must be concerned with. One very common lien in Massachusetts accident cases is the MassHealth lien.  

Overview of MassHealth and Its Liens

In Massachusetts, certain qualifying residents are able to apply for and obtain health insurance coverage through the Commonwealth of Massachusetts’ Medicaid program. This is commonly known as MassHealth. MassHealth is available for individuals in Massachusetts who do not have or cannot afford private health insurance.

The MassHealth insurance is funded by state and the federal government. The Commonwealth of Massachusetts, however, manages the plans. Part of the management of these plans include determining the legal liability of third parties to pay for medical treatment or services that are available with the MassHealth plan. This is what gives MassHealth the legal power to have a lien on a personal injury case.

A MassHealth lien is similar to any other type of medical provider or health insurer lien on a personal injury case. One major difference is that MassHealth’s lien is automatic and requires no notice of the lien to be valid. A medical provider or health insurer must perfect their lien on an injury or accident case by providing proper notice under Mass. Gen. Laws ch. 111 § 70B (which requires the provider or insurer to mail a notice of the lien to the plaintiff or his personal injury attorney by certified mail, with return receipt requested). MassHealth does not need to comply with this requirement.

How MassHealth Liens Effect a Personal Injury Case

In a case where a MassHealth recipient is injured in an accident caused by someone else’s  negligence he or she may file a claim for personal injuries seeking financial compensation for the injuries and consequential losses stemming from the accident. MassHealth will have an automatic lien on the personal injury case or claim for any medical bills MassHealth pays for related treatment. As discussed above, pursuant to Massachusetts law, if the injured person receives a settlement from the at-fault party’s insurance company, MassHealth must be reimbursed for the medical bills it paid or medical assistance it provided for any treatment related to the injuries suffered in the accident.

Let’s look at an example: Paula lives in Framingham, MA. One day she drops her child off at school in the morning and then heads to the grocery store to do some shopping. While driving to the store, she stops at a red light. As she is waiting for the light to turn green, she is suddenly rear-ended by David. Paula is in serious pain from the car crash and she calls 911. David apologizes to her because he was looking down at his phone and didn’t see the light was red. An ambulance arrives on scene and Paula is brought to the emergency room. It is subsequently discovered that Paula suffered a serious neck and back injury.

Paula then hires a Massachusetts personal injury lawyer, who files a bodily injury claim with David’s auto insurance company. Over the course of several months, Paula undergoes extensive treatment consisting of physical therapy, MRIs and cortisone injections. When she reaches a maximum medical improvement for the injures she suffered in the car accident, her lawyer submits a demand for settlement to David’s insurance company.

Paula’s total medical bills were $15,000. Because Paula has MassHealth, they have an automatic right to be repaid for the medical bills they covered for the treatment related to the injured suffered in the car accident. Paula’s auto insurance company, however, paid the first $8,000 from her Personal Injury Protection Benefits (PIP). Therefore, the outstanding medical bills would be $7,000. This doesn’t mean that Paula would have to pay MassHealth $7,000. MassHealth would only be entitled to the actual amount they paid for the medical treatment. MassHealth most likely only paid a percentage of the total outstanding medical bills. This is why Paula (or her attorney) must know what MassHealth actually paid before attempting to negotiate a settlement. That way she will know exactly how much she must repay MassHealth and can then estimate the amount she may recover from a settlement.

Let’s assume MassHealth only paid $2,000 of the outstanding $7,000 in medical bills. Their lien would be for the actual $2,000 they paid. So, when estimating the amount Paula would net from a settlement, she must take into consideration the repayment to MassHealth, in addition to any other deductions from the settlement (e.g., attorneys fee, litigation costs and expenses).

Insurance companies are required to check with MassHealth to see if they are owed any money before issuing a settlement check on a personal injury case or claim. If MassHealth is owed money, after reaching a settlement the insurance company will either name MassHealth as a payee on the settlement check or issue a separate check for the amount owed directly to MassHealth. If Paula settles her case and signs a Release of All Claims before determining how much MassHealth must be repaid, she cannot later go back to David’s insurance company and ask for more money for the settlement because MassHealth must be paid. Failing to determine how much MassHealth is owed could result in Paula receiving much less money or no money at all from her settlement.

The lesson here is, if you are a MassHealth recipient and you have a personal injury claim outstanding, make sure you determine how much MassHealth is entitled to be repaid before you settle your injury claim or case.

What Can Be Done With A MassHealth Lien?

There are numerous things that must be examined before accepting a settlement and paying MassHealth back. Just because MassHealth is legally entitled to be repaid for the medical assistance or benefits they paid for treatment related to an accident, doesn’t mean that if MassHealth say you owe them a certain dollar amount, that it is the correct amount.

MassHealth will provide an itemized list of medical bills they paid and included in their lien. The liens and itemized bills must be thoroughly scrutinized. As stated above, MassHealth is entitled to be repaid for medical bills they paid for treatment related to the accident. Occasionally, MassHealth will include in its lien medical bills they paid for treatment that may not be related to the accident.  For instance, they may include a medical bill they paid when you went to your primary care doctor with a sore throat, which is totally unrelated to any injuries you suffered in an accident. In that situation, you can seek to have that bill removed from the lien and the lien reduced.

In other situations, MassHealth may pay some medical bills before PIP exhausts the $8,000 they are required to pay. Remember, PIP will pay the first $8,000 of medical bills for treatment related to injuries suffered in a car accident in Massachusetts. Sometimes, MassHealth will inadvertently pay medical bills before PIP has paid the full $8,000. If that is the case, you or your personal injury attorney, should coordinate with the auto insurance carrier and MassHealth to have the medical bills paid by the responsible insurer.

In other cases, where the MassHealth lien is for all treatment related to the accident and otherwise valid and accurate, MassHealth may still reduce their lien. This can be accomplished if properly negotiated. There are many factors that go into negotiating a reduction in a MassHealth lien. It is always best for anyone with MassHealth, who has been injured in an accident in Massachusetts, to consult with an experienced Massachusetts personal injury lawyer. An experienced accident attorney will be able to determine if a MassHealth lien or any other type of lien on your personal injury case is valid, accurate and able to be reduced. This will help secure more of the settlement for you and your family.

Speak With An Experienced Massachusetts  Accident Lawyer Today

If you have MassHealth for health insurance and you were injured in an accident caused by someone else, you should discuss your case with an experienced attorney in order to understand and protect your rights. As discussed above, MassHealth may have an automatic lien on your case. Having an experienced attorney evaluate your accident case, may result in you receiving more money from any potential settlement.

Mahaney & Pappas, LLP has well over 40 years of combined experience helping accident victims get the compensation they deserve. If you have questions about an accident case, feel free to contact us online or call us at (508) 879-3500. We are happy to evaluate your case, answer your questions and explain how you can secure the financial compensation you deserve.