Subrogation Laws in All 50 States - Interactive Map

Click on your state for a brief summary of that state's laws affecting or impacting subrogation recoveries.

 

To receive a call back today to answer any of your questions, email us at [email protected]

Connecticut Subrogation Laws

NO SUBROGATION

CGS §52-225c states that (except as otherwise provided by law) no insurer providing collateral source benefits shall be entitled to recover the amount of any such benefits from the defendant or any other person as a result of any claim for damages for personal injury (this excludes ERISA plans). This provision only applies to contracts issued, reissued, or renewed after October 1, 1986. Nuzzo v Nationwide Mut Ins Co, No. 394015, 1999 WL 240729.

Made Whole Doctrine

YES, can be overridden by contract terms

Fireman’s Fund Ins. Co. v TD Banknorth Ins. Agency, Inc., 2013 WL 3818112 (Conn. 2013). The court held officially adopted the Made Whole Doctrine in this case. The Made Whole Doctrine is now a default rule in Connecticut insurance contracts. The court also stated that the Doctrine was not relevant when it comes to an obligation to reimburse a deductible.

Common Fund

Not applicable

Collateral Source rules

CGS §52-225a states that an award shall be reduced by an amount equal to the amounts the plaintiff received as collateral source benefits less the total amounts determined to have been paid, contributed, or forfeited under CGS §52-225c, except that there shall be no reduction for which a right of subrogation exists.

Hospital Lien Act

  • CGS §49-73(a): a hospital shall have a lien on the proceeds of any accident and liability insurance policy, to the extent of the actual cost of such service and materials
    • Hospital must serve written notice upon the insurance company
    • Essentially no case law on this issue, no mentions of attorney’s fees
  • Balance billing is prohibited (CGS §20-7f)

Medicaid Statute

(There are multiple ways for Medicaid to be reimbursed)

  • CGS §17b-94: in the case of causes of action of beneficiaries of aid under the state supplement program, medical assistance program, aid to families with dependent children program, or under 17b-93, the claim of the state shall be a lien against the proceeds therefrom
    • Cap: the amount of assistance paid or 50% of the proceeds received by the beneficiary after payment of expenses connected with the claim, whichever is less
    • Subordinate to claims for attorney’s fees
  • CGS §17b-265: department of social services shall be subrogated to any right of recovery that recipient of medical assistance has against a third party for the cost of all health care items or services furnished to the recipient
    • Cap: not to exceed the amount expended by the department for such care
    • Recipient of benefits automatically makes a subrogation assignment and assignment of claims for benefits to the department
    • Claims for recovery submitted by the department shall not be denied solely on the basis of the date of submission or lack of prior authorization as long as the claim is submitted by the state within the 3 year period beginning when the service was furnished and the claim to enforce such rights is commenced within six years of the claim submission
  • State v. Peters, 946 A.2d 1231 (Conn. 2008): the state can pursue claims against the liable third party directly or indirectly through placing a lien on personal injury judgments
    • Reduction: when seeking reimbursement from the accident victim who had already recovered damages from the third-party, the state is not required to reduce reimbursement for attorney’s fees
  • No mentions of who the notification burden is on

Cases

Pajor v. Town of Wallingford, 704 A.2d 247 (Conn. App. Ct. 1997): health insurance subrogation provision is invalid under 52-225c

To receive a call back today to answer any of your questions, email us at [email protected]