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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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Utah Subrogation Laws
Sections
State Subrogation
Made Whole Doctrine
Common Fund
Collateral Source Rule
Hospital Lien Act
Medicaid Statute
State Subrogation
YES, equitable and contractual.
Made Whole Doctrine
YES, can contract around
To contract around, language must be sufficiently clear and unambiguous (State Farm Mutual Auto. Ins. Co. v. Green, 89 P.3d 97 (Utah 2003)).
Common Fund
Acknowledged, unclear if it applies in medical benefits cases
Kramer v. State Retirement Bd. is a health insurance case that recognizes the existence of the doctrine but does not address whether it applies. When the party tried to assert the doctrine, the court said that the cases the party cited only applied the doctrine in class action situations, not insurance subrogation situations, and thus said that the party’s theory does not apply in this case (Kramer v. State Retirement Bd., 195 P.3d 925 (Utah Ct. App. 2008)).
The footnotes in Stewart v. Utah Public Service Com’n also acknowledge the doctrine, but do not answer whether it applies in medical benefits situations (Stewart v. Utah Public Service Com’n, 885 P.2d 759 (Utah 1994)).
Collateral Source Rule
Applies, evidence is inadmissible
Hospital Lien Act
- Utah Code Ann. §38-7-1:
- A hospital has a lien on the portion of the judgment/settlement belonging to the patient, less the amount paid by the patient for attorney’s fees, court costs, and other necessary expenses
- No other reduction of the lien is allowed unless otherwise agreed to in writing
- A hospital may file a lien for the amount of reasonable, usual, and necessary hospital charges up to the date of payment of the damages
- The hospital lien does not apply to a settlement/judgment where the amount is $100 or less
- A hospital has a lien on the portion of the judgment/settlement belonging to the patient, less the amount paid by the patient for attorney’s fees, court costs, and other necessary expenses
- Utah Code Ann. §38-7-2: A hospital lien shall be effective if:
- Written notice is filed in the district court
- A copy of the written notice is mailed to the interested parties and insurance companies
- Utah Code Ann. §38-7-3:
- A person who fails to meet the notice requirements is precluded from receiving an award of costs and attorney’s fees from the person against whom a notice of lien has been filed in an action to enforce the lien if costs and attorney’s fees are authorized by contract or statute
- A lien claimant who, within 20 days from the date of receiving notice of noncompliance with the notice requirements, willfully refuses to release the notice of lien is liable to the person against whom the notice of the lien was filed for $1,000 or treble damages, whichever is greater
- Failure to meet the notice requirement does not invalidate the lien
Medicaid Statute
- Utah Code Ann. §26-19-4.5: all benefits for medical services or payments from a third party are assigned to the department
- Utah Code Ann. §26-19-5:
- the department has a lien against any proceeds payable to or on behalf of the recipient by a third party. This lien has priority over all other claims to the proceeds, except claims for attorney’s fees and costs
- department must mail written notice of its claim to all interested parties
- the department may waive, compromise, settle, or release a lien
- Utah Code Ann. §26-19-7:
- a benefits recipient must give notice to the department when filing a claim
- the department shall provide the recipient’s attorney the opportunity to enter into a collection agreement with the department (a few exceptions in statute)
- if the attorney enters into a collection agreement, or includes the department’s claim in the recipient’s claim or action, the department shall pay attorney’s fees at the rate of 33.3% of the department’s total recovery and shall pay a proportionate share of the litigation expenses directly related to the action