Subrogation Laws in All 50 States - Interactive Map

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

 

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Maine Subrogation Laws

State Subrogation

YES, statutory only (not equitable)

Equitable subrogation is not allowed when a person pays a fee in order to contractually oblige a person/entity (such as an insurer) to perform a service.  Medical insurance plans fall into this category and thus equitable subrogation is not available (McCain Foods, Inc., v. Gerard, 489 A.2d 503 (Me. 1985))

Me. Rev. Stat. tit. 24-A, §2729-A: subrogation provisions are not allowed unless the provision is approved by the superintendent, and it must require the written approval of the insured and allows reimbursement payments only on a just and equitable basis (not on the basis of a priority lien).  A just and equitable basis means that any factors that diminish the potential value of the insured’s claim shall likewise reduce the reimbursement payment.  Factors include:

  • Legal defenses: questions of liability and comparative negligence or other legal defenses
  • Exigencies of trial: exigencies of trial that reduce a settlement or award in order to resolve the claim
  • Limits of coverage: limits on the amount of applicable insurance coverage that reduce the claim to an amount recoverable by the insured

Me. Rev. Stat. tit. 24-A, §2836: No group or blanket policy shall provide for priority over the insured member of payment for any medical services/expenses paid or reimbursed under the policy, in the even the insured is entitled to receive payment from another person as a result of legal action.  The exceptions to this are the same as above – must be approved and allows payments on a just and equitable basis.

Made Whole Doctrine

Not really addressed in the health insurance context.

Only thing to go off of is the just and equitable basis for reductions of reimbursement provided for in the statute.

Common Fund

YES, must pay share of fees/expenses.

York Ins. Grp. of Maine v. Van Hall, 704 A.2d 366 (Me. 1997).

“(1) common fund doctrine requiring each party to pay share of expenses incurred in creating fund, including reasonable attorney fees, applied; (2) insurer’s actual knowledge of insured’s intention to seek recovery from tort-feasor was sufficient notice to insurer; and (3) subrogation clause did not preclude application of common fund doctrine.”

Collateral Source Rules

Evidence of payments is not admissible

Hospital Lien Act

  • Rev. Stat. tit. 10, §3411: hospitals are entitled to a lien for the reasonable charges for hospital care, etc., except that no entitlement to such a lien may exist against the principal residence of any person in any 12-month period during which that person is eligible for financial assistance under the catastrophic illness program
    • Attorney’s must be paid first
  • Rev. Stat. tit. 10, §3412: no lien shall be perfected without written notice filed with the clerk of the municipality not later than 10 days after the patient has been discharged; also, written statement must be mailed to all interested parties
  • Rev. Stat. tit. 24-A, §4303(8-A): protects against balance billing by providers

Medicaid Statute

  • Rev. Stat. tit. 22, § 14(1): The commissioner has a right of recovery from the third party. The commissioner must also be subrogated to the extent of benefits provided under MaineCare (Medicaid).  This constitutes a statutory lien.
    • The commissioner can recover the cost of benefits paid out when he has determined that collection will be cost-effective to the extent that there are proceeds available for such recovery after the deduction of reasonable attorney’s fees and litigation costs from the gross award or settlement. In determining whether it is cost effective, the commissioner shall consider all factors that might diminish potential recovery, including questions of liability and comparative negligence, exigencies of trial, and limits on the amount of insurance coverage
    • The department’s statutory lien may not be reduced to reflect an assessment of a pro rata share of the attorney’s fees or litigation costs
    • The commissioner may compromise or waive a claim if he determines collection will not be cost-effective or lead to the best possible outcome
  • Rev. Stat. tit. 22, § 14(2-A): the receipts of MaineCare benefits constitutes an assignment of recovery rights. The department’s assigned right to recover is limited to the amount of medical benefits received by the recipient
  • Rev. Stat. tit. 22, § 14(2-D): recipient of benefits must notify department when they are making a claim

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