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District of Columbia Code Division V. Local Business Affairs § 31-3551. Reduction of health care benefits lien.

Current as of January 01, 2024 | Updated by Findlaw Staff

(a) Except as provided in subsection (d) of this section, this chapter shall apply to any right of subrogation under a contract or applicable law for payment of health-care benefits or services for an injured person paid or payable by a subrogee or under any system of self-insurance or indemnification for health-care expenses, if the amount of the subrogee's claim as determined under subsection (b) of this section is voluntarily paid by the injured person from the injured person's recovery in a claim for personal injury.

(b)(1) Unless a subrogee files a petition to intervene in the personal injury action and is independently represented by counsel, in a subrogation claim arising out of a claim for personal injury, the amount permitted to be recovered by a subrogee for health-care benefits or services paid or payable on behalf of the injured person, subject to paragraph (2) of this subsection, shall be reduced by dividing the total amount of the costs of litigation and the attorneys' fees incurred by the injured person for services rendered in connection with the injured person's claim for personal injury by the amount of the total recovery in the claim for personal injury and multiplying the result by the amount of the subrogee's subrogation claim.

(2) The result under paragraph (1) of this subsection shall not exceed one-third of an injured person's recovery in a claim for personal injury.

(3) A subrogee has no obligation to advise an injured person or the attorney for the injured person of the injured person's right to a reduction of the subrogation claim.

(c) On written request by a subrogee, an injured person or the attorney for the injured person who demands a reduction of the subrogation claim as described in this chapter shall provide the subrogee with a certification by the injured person that states the amount of the attorneys' fees and the costs of litigation incurred by the injured person in connection with the injured person's claim.

(d) This chapter shall not apply to:

(1) A voluntary reduction of a subrogation claim by a subrogee that exceeds the reduction of the subrogation claim as described in subsection (b) of this section; or

(2) The District of Columbia Medicaid program.

(e) For the purposes of this chapter, the term “subrogee” means any person or entity that provides accident and sickness benefits or medical, surgical, or hospital benefits, whether on an indemnity or a reimbursement basis or a prepaid basis, including insurance carriers, and employers.

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Cite this article: FindLaw.com - District of Columbia Code Division V. Local Business Affairs § 31-3551. Reduction of health care benefits lien. - last updated January 01, 2024 | https://codes.findlaw.com/dc/division-v-local-business-affairs/dc-code-sect-31-3551/

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