Stanton v. State Farm Mutual Insurance

Stanton v. State Farm Mutual Insurance
Automobile Insurance Company
No. 11-cv-282-JPG-DGW

2011 WL 3678912 (S.D.Ill.Aug. 22, 2011) 

This case involved an attempt by a defendant insurer (State Farm) to include Medicare’s recovery contractor (MSPRC) on the settlement check in relation to the resolution of a wrongful death claim to ensure that Medicare’s interests were properly protected for conditional payments issued by Medicare.

The plaintiff objected and sought a court order from the Illinois state court ruling that the MSPRC need not be included as a payee on the settlement draft.  State Farm filed an interpleader action against the Secretary of the Department of Health and Human Services bringing Medicare into the action. Continue reading “Stanton v. State Farm Mutual Insurance”

Benson v. Sebelius

Benson v. Sebelius
Civil Action No. 09-1931 (RMU),
2011 WL 1087254
(D. D.C. March 24, 2011)

This case involved a wrongful death and survival action. The parties settled the claim for $90,000, with 80% of that amount allocated for the wrongful death settlement award and 20% allocated for the survival claim. Medicare issued a final demand for conditional payment recovery in the amount of $25,868.58.

Benson challenged Medicare’s recovery claim arguing that under the Medicare Secondary Payer Statute (MSP) CMS can only recover from that aspect of the settlement related to the Medicare beneficiary’s estate and not from the wrongful death part of the settlement per the per the court’s decision in Bradley v. Sebelius, 621 F.3d 1330 (11th Cir., Sept. 29, 2010). In addition, Benson contended that one of the administrative bodies’ alleged failure to provide him with a requested transcript in a timely manner during the administrative appeals phase of the action violated his 5th Amendment due process rights.

The court rejected the plaintiff’s arguments and ruled in favor Medicare. In reaching its decision that court found the Benson case was factually and legally different from Bradley. For reasons more fully explained in the court’s ruling, the court, in part, found that Medicare could recover its full claimed amount in that in Benson (unlike in Bradley) the plaintiff claimed compensation for the decedent’s medical costs as part of his wrongful death claim. The court also found that there was no violation of 5th Amendment due process rights.

Bradley v. Sebelius

Bradley v. Sebelius
621 F.3d 1330
(11th Cir., Sept. 29, 2010)

This case involved a wrongful death action filed under the Florida Wrongful Death Act for alleged nursing home neglect. The decedent (Mr. Burke) was survived by 10 children. One of his daughters (Cardonvella Bradley) was named personal representative of the estate.

Bradley filed a wrongful death action against the nursing home through which damages were claimed for the estate and the ten surviving children per Florida law. The action was eventually settled without a formal action being filed in court for the nursing home’s policy limits — $52,500. This sum was undifferentiated between the parties.

Medicare asserted a conditional payment claim in the amount approximately $22.480.89 (with said figure representing the full amount of Medicare’s conditional payments minus applicable procurement costs). Bradley requested that Medicare reduce its claim on various grounds. Medicare refused and demanded a full recovery. Continue reading “Bradley v. Sebelius”

Hadden v. U.S.

U.S. v. Hadden
No. 1:08-CV-10, 2009 WL 2423114
(D. W.D. Ky, Aug. 6, 2009)

This case involved a pedestrian plaintiff, Mr. Hadden, who was struck by a utility truck as he was walking on a sidewalk. The accident was caused when an unidentified driver ran a stop sign thereby cutting off the utility truck causing it take evasive action. In doing so, the utility struck Mr. Hadden causing bodily injury. Mr. Hadden sued the utility truck driver but was unable to file suit against the driver who ran the stop sign (the phantom tortfeasor) as he/she could not be found.

Mr. Hadden eventually reached a settlement with the utility truck driver in the amount of $125,000. Medicare issued a conditional payment demand upon Mr. Hadden for approximately $64,252.37 (said figure representing the full amount of the conditional payments issued by Medicare less applicable procurement costs). Continue reading “Hadden v. U.S.”

Tomlinson v. Landers & Zaleppa v. Seiwell

Tomlinson v. Landers,
No. 3:07-CV-1180-J-TEM, 2009 WL 1117399
(D. M.D. FL April 24, 2009)

AND

Zaleppa v. Seiwell
No. 219 MDA 2009,
2010 WL 4633467
(Pa. Super. Ct., Nov. 17, 2010)

In these cases, the primary payer was insisting that the Medicare be a named payee on the settlement check (i.e. “putting Medicare on the check”) to ensure that Medicare was reimbursed for conditional payments. However, the court in both cases ruled that based on the operable facts there was no authority under the MSP giving the primary payer the right to insist that Medicare be a named payee on the settlement check.