Missouri Subrogation Laws

State Subrogation

NO, not allowed in medical benefits subrogation, assignment is prohibited in personal injury cases

Made Whole Doctrine

N/A

Common Fund

N/A

Collateral Source Rules

Mo. Ann. Stat. §490.715 governs

Parties may introduce evidence of the value of the medical treatment rendered to a party that was reasonable, necessary, and a proximate result of the negligence of any party.

In determining the value of medical treatment, there shall be a rebuttable presumption that the dollar amount necessary to satisfy the financial obligation to the health care provider represents the value of medical treatment.  Upon motion of any party, the court may determine the value of medical treatment based upon additional evidence, including the medical bills incurred by a party, the amount actual paid for treatment, and the amount of bills not paid which such party is obligated to pay to any entity in the event of a recovery

August 28, 2017, that portion of the statute was repealed and there is no longer a presumption. There is now an “actual cost” standard. Medical bill evidence allowed is now only the amount actually paid or owed, and not the originally billed amount, or any write-offs, discounts, or adjustments to the bill as a result of contracts with insurers or government programs. Some plaintiffs may now intentionally omit claims for medical expenses.

Hospital Lien Act

Mo. Rev. Stat. §§ 430.225 – 250

• Mo. Ann. Stat. §430.230: Every hospital has a lien upon any claims of any person admitted to the hospital for the cost of such services, computed at reasonable rates not to exceed $25 per day and the reasonable cost of necessary tests and treatment
• Mo. Ann. Stat. §430.250 Amount and Cap: the lien cannot be more than 50% of the settlement/judgment left over after deducting for attorneys’ fees
• Mo. Ann. Stat. §430.240: no lien shall be effective unless written notice is sent to all interested parties
• Mo. Ann. Stat. § 430.225(3). Missouri mandates that hospitals pay a proportionate share of recovery expenses if the lien is over 50% of the total net proceeds. The net proceeds are calculated after attorneys’ fees are taken out of the recovery amount.
• Hospital liens do not extend to rights an injured person may have under first-party insurance coverage which they, their family, or their employers may have procured for the injured person’s benefit. This includes UM benefits. Such first-party insurance coverage cannot fairly be construed to fall within § 430.235’s reference to “claims … which such injured person may have … against the person or persons causing such injury.” Truman Medical Center, Inc. v. Progressive Casualty Ins. Co., 597 S.W.3d 362 (Mo. App. 2020).

Medicaid Statute

(Court has a lot of discretion in determining what portion of the recovery the state can get – see many factors below)

• Mo. Ann. Stat. §208.215(8): The department/division has a lien upon any settlement/judgment paid to a recipient. A lien notice shall be served upon all interested parties
• Mo. Ann. Stat. §208.215(9): the court may determine what portion of the recovery shall be paid to the department. In making this determination, the court shall conduct an evidentiary hearing and consider the following evidence:
  • the amount of the charge sought to be enforced against the recovery when expressed as a percentage of the gross amount of the recovery; the amount sought when expressed as a percentage of the amount obtained by subtracting from the gross amount of the recovery the total attorney’s fees/costs; and whether the department should, as a matter of fairness and equity, bear its proportionate share of fees/costs
  • the amount of attorney’s fees and costs incurred by the participant
  • the total hospital/medical expenses incurred, the portion of the expenses paid by the participant, by insurance, and by the department, and the amount still unpaid
  • whether the recovery represents less than substantially full recompense for the injury, so that reduction of the charge sought would not likely result in a double recovery or unjust enrichment to the participant
  • the age of the participant and of the persons dependent on the participant, the nature and permanency of the injuries, foreseeable future material costs
  • the realistic ability of the participant to repay in whole or in part the charge sought to be enforced against the recovery when judged in light of the factors enumerated above
• Mo. Ann. Stat. §208.215(10): the burden of producing evidence to reduce the amount of a charge sought to be enforced shall be on the party seeking the reduction
• Mo. Ann. Stat. §208.215(11): the court may reduce and apportion the department’s lien proportionate to the recovery of the claimant. The court may consider the nature and extent of the injury, economic and noneconomic loss, settlement offers, comparative negligence, hospital costs, etc.   The department shall pay its pro rata share of the attorney’s fees based on the department’s lien as it compares to the total settlement agreed upon
• Mo. Ann. Stat. §208.215(12): whenever the department has a charge under this section, such charge shall not be satisfied out of any recovery until the attorney’s claim for fees is satisfied
• Mo. Ann. Stat. §208.215(3): any participant must notify the MO HealthNet division when they are pursuing rights of recovery against liable third parties
• Mo. Ann. Stat. §§208.215(4-7): any recipient assigns their recovery right to the department or MO HealthNet division; the division has the right to recover the amount of payments made