Guide · Insurance

Subrogation, Reimbursement, and Liens: A Comprehensive Guide to ERISA Plans, Medicare, Medicaid, and the Made-Whole Doctrine

29 U.S.C. § 1144

Type
Guide
Jurisdiction
National
Date
2025-04-06
Topic
Insurance

This guide explains the law governing every entity that claims a share of a personal injury recovery, organized by payer type because each payer operates under a different legal framework. It covers ERISA plan reimbursement and the equitable-lien line running from Great-West through Sereboff, McCutchen, and Montanile, and explains why the self-funded versus insured distinction determines whether state made-whole and anti-subrogation laws apply. It covers the Medicare Secondary Payer framework, conditional payment recovery, the dispute and appeal process, and future-medicals treatment. It covers Medicaid's anti-lien provision as construed in Ahlborn, Wos, and Gallardo, and the allocation practice that follows. It covers state hospital and provider liens, workers' compensation liens and credits, federal programs including the Federal Medical Care Recovery Act, FEHBA, TRICARE, and the VA, and the equitable doctrines that limit recovery. It closes with negotiation strategy, disbursement discipline, and the malpractice exposure that lien work creates. Each part identifies the governing authority, the documents that control, and the arguments that actually reduce a claim.

Subrogation, Reimbursement, and Liens: A Comprehensive Guide to ERISA Plans, Medicare, Medicaid, and the Made-Whole Doctrine

Insurance > Subrogation, Reimbursement, and Liens | Published 6 April 2025 - Updated 22 April 2026 | UpLaw - uplaw.us

How to use this guide

Lien resolution is not one body of law. It is six or seven bodies of law that happen to converge on the same pot of money, and the single most common error in practice is applying the rules of one to the claim of another. A state made-whole statute that defeats an auto carrier's subrogation claim does nothing to a self-funded ERISA plan. An equitable defense that reduces a hospital lien has no application to Medicare. A negotiation posture that works with a Medicaid agency will be ignored by a sophisticated recovery vendor holding plan language drafted specifically to eliminate it.

The full text of this document is available to Executive subscribers and above. See plans.