Private Lien Resolution Program Agreement
183. What is the Private Lien Resolution Program (“PLRP”)?
The Lien Resolution Administrator reached agreements with the Rawlings Group, Equian, and Optum to resolve Medicare Part C and private health insurance Liens for two types of Claimants:
(a) Exempt: Claimants who are found by the Claims Administrator to have received no treatment or limited treatment for an injury. The Rawlings Group, Equian, and Optum and their clients will NOT pursue recovery from any Claimant in these groups, meaning there will be no associated repayment obligations or holdbacks.
(b) Non-Exempt: Claimants who are found by the Claims Administrator to have received more than two distinct healthcare evaluations or office visits for an injury. The Lien Resolution Administrator will share necessary information with the Rawlings Group, Equian, and Optum to identify and resolve applicable Medical Liens
184. Are Non-Exempt Claimants required to participate in the PLRP?
No. Any Non-Exempt Claimant who does not want to participate in the PLRP must opt out of the PLRP. To opt out, Claimants (or their lawyers, if represented) must email the Claims Administrator with the names and Claimant IDs of those individuals who wish to opt out of the PLRP. The deadline to opt out of the PLRP passed on February 22, 2021. If you want to opt out now, contact the Claims Administrator as soon as possible, and the Claims Administrator will advise as to whether the late request can be accepted.
For Claimants who opted out of the Private Lien Resolution Program and received medical treatment for injuries on the submitted claim, the Trust will withhold 100% of any awards for Personal Injury or Emotional Distress Claims until the Lien Resolution Administrator receives sufficient proof of satisfaction and discharge of the Lien. When the final Lien amount is determined, the Trust will use the withheld funds to pay the lienholder and pay the Claimant any remaining funds.
185. What happens if I do not opt out of the PLRP?
The Rawlings Group, Equian, Optum, and the Lien Resolution Administrator will work together to determine the amount of injury-related healthcare paid by your health plan. The Rawlings Group, Equian, and Optum will provide the Lien Resolution Administrator with any insurance claims related to your injuries, and the Lien Resolution Administrator will review those insurance claims to confirm that they are related to your compensable injuries. After the Lien Resolution Administrator completes this audit of the insurance claims provided by the Rawlings Group, Equian, and/or Optum, the Claims Administrator will apply approved reductions to lower your repayment obligations. You (or your lawyer, if you are represented) will have 21 days to approve or appeal the final repayment amount.
186. What approved reductions will the Claims Administrator apply to repayment obligations under the PLRP?
After the Lien Resolution Administrator’s audit of the insurance claims asserted by your health plan, your repayment obligation will be reduced by 40%. For example, if the plans participating in the PLRP provide $12,000 in insurance claims related to your injuries, of which only $10,000 is confirmed by the Lien Resolution Administrator to be related to your compensable injuries, the $10,000 will be reduced by 40%, down to $6,000. This reduced amount also cannot exceed the Lien cap set by the PLRP.
187. What Lien caps are set by the PLRP?
The PLRP includes caps to limit the amount that will be repaid from any individual Claimant’s award. All PLRP Liens will be satisfied from only the portion of the Claimant’s awards for Personal Injury and Emotional Distress Claims related to medical care, and not from any other economic-based Claims and awards. After deducting any amounts paid by the Claimant to other governmental lienholders, a Claimant’s Liens will never exceed:
(a) 25% of the Net Claim(s) amount paid to date for Medicare Part C plans; or
(b) 22.5% of the Net Claim(s) amount paid to date for private and other plan types.
In the rare event that the first 25% or 22.5% holdback from your pro rata payment(s) is insufficient to satisfy 100% of your PLRP Lien obligations, the Lien Resolution Administrator will continue to hold back and pay up to 25% of any future pro rata payment(s) towards satisfying the Lien(s).
188. Am I responsible for paying the costs associated with resolving my Medical Liens through the PLRP?
No. There will be no direct costs to you for the assistance and expertise provided by the Claims Administrator and Lien Resolution Administrator to administer the PLRP.
189. What happens if I opt out of the PLRP?
If you opt out of the PLRP, you (or your lawyer, if you are represented) will be responsible for obtaining either a final Lien amount or confirmation that the private health insurer has no interest in your award. The Claims Administrator will hold back funds from any Personal Injury Claims or Emotional Distress Claims related to medical care until you or your lawyer submits sufficient proof that any reimbursement interest from the insurers disclosed in the Claims Questionnaire has been resolved.
190. What if I have medical expenses covered by a health insurance plan that is not part of the PLRP?
If you claimed an injury that required treatment and your insurer disclosed in the Claims Questionnaire is not a PLRP Participating Private HealthPlan, then any potential Lien(s) will be your responsibility to resolve outside the Trust, and the Claims Administrator will not withhold any funds from your award for those potential Lien(s).
