Missouri generally speaking does not allow reimbursement rights to private health insurance plans.

What is ERISA law? #

Federal law preempts state law and there is it’s called ERISA Law and Car Accidents . Employee Retirement Income Security Act, basically, a federal law that governs these health insurance plans, and sometimes they are allowed to be reimbursed from your car accident settlement.

It’s very important to really figure out if they have those reimbursement rights. Because sometimes they will claim to have them, then when you look at their plan language and it’s clear as day that they’re not.

So, it’s very important to figure out if the plan is actually self-funded. And, there’s a couple of ways to go about doing it, so if the plan is provided by your employer or your spouse’s employer and you’re covered by that plan, you have to look a little bit deeper. However, if you get that plan from a private place, so you get it from a broker, most likely or in most instances is not self-funded and they don’t have a reimbursement right.

Health insurance plan #

To dig deeper, so, one of the other ones is if the health insurance plan is provided by the federal or state government. Those are actually not governed by ERISA. There’s a separate federal law that governs the state or federal governments. It’s… The name slips my mind right, but it’s a different federal law.

That if the plan is provided by the employer they have to fill out some forms with the government. One of those forms is the 5500, and when you take a look at that form It’s basically a tax form if you take a look at that form. And if the box check just saying insurance, then you’re probably not dealing with a self-funded plan.

However, if the general assets are checked or trust is checked on that form. Then you need to do some further investigation and figure out if they really are a self-funded plan. However, nothing is more important than taking a look at the plan language itself.

My advice #

So, what I always advise my clients is, get me the entire policy. The entire plan, so we can dig deep and figure out if they are entitled to reimbursement under the ERISA laws. If they aren’t entitled to reimbursement obviously we have to pay them.

It’s important to figure that out before you settle the case. They are only entitled to get that money back if you make a recovery. They know before we settle the case, if they don’t want to negotiate with it then we’ll just walk away and nobody’s going to get anything.

So, in most instances there are in the plan itself for example, there are provisions on getting those liens reduced. We are in most instances able to get them reduced drastically. So, more money remains in our client’s pockets.

If you have any questions? Please don’t hesitate to give me a call at 314-352-6800.

Bajric & Ramic Law Office
Nedim Ramic – Auto Accident Lawyer – Personal Injury Attorney