If one of your plan members is injured as the result of an accident, it’s possible that subrogation may be necessary. Subrogation is a recovery process in which medical claim costs resulting from the injury, initially covered by the employer, are reimbursed from a third party (i.e., an individual, insurance company, a public program, or a private entity) found responsible for payment.
But why not seek recovery from the responsible party first, rather than the employer paying claims? The answer lies in the difficulty of determining recovery potential without investigating the accident beforehand. It also has to do with complicated state laws governing recovery and payment.
There may be a question following an accident as to who was at fault, or possibly the individual responsible has no insurance or other resources from which recovery could be made. Further, the determination as to whether there is a potential for recovery is usually made long after the initial claim is filed, and delays in payment may violate ERISA guidelines, endanger provider discounts, and impose a hardship on the member.
To help employers successfully navigate the recovery process, MedBen offers subrogation services through The Phia Group. The Phia Group works directly with participants (and their attorneys, if applicable) to gather accident details and charges a percentage of the amount recovered as its fee for reviewing and handling subrogation matters.
MedBen is dedicated to ensuring that you pay only for claims for which your plan is responsible. Should you ever have a question regarding a subrogation matter, your MedBen Account Management team will be glad to assist you.