Utah Code 26B-3-1009. Recovery of medical assistance from third party — Lien — Notice — Action — Compromise or waiver — Recipient’s right to action protected
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Terms Used In Utah Code 26B-3-1009
- Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
- Claim: means :(3)(a) a request or demand for payment; or(3)(b) a cause of action for money or damages arising under any law. See Utah Code 26B-3-1001
- Dependent: A person dependent for support upon another.
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Lien: A claim against real or personal property in satisfaction of a debt.
- Medical assistance: means :
(8)(a) all funds expended for the benefit of a recipient under this chapter or Titles XVIII and XIX, federal Social Security Act; and(8)(b) any other services provided for the benefit of a recipient by a prepaid health care delivery system under contract with the department. See Utah Code 26B-3-1001- Recipient: means :
(11)(a) an individual who has applied for or received medical assistance from the state;(11)(b) the guardian, conservator, or other personal representative of an individual under Subsection (11)(a) if the individual is a minor or an incapacitated person; or(11)(c) the estate and survivors of an individual under Subsection (11)(a), if the individual is deceased. See Utah Code 26B-3-1001- State: when applied to the different parts of the United States, includes a state, district, or territory of the United States. See Utah Code 68-3-12.5
- Third party: includes :
(15)(a) an individual, institution, corporation, public or private agency, trust, estate, insurance carrier, employee welfare benefit plan, health maintenance organization, health service organization, preferred provider organization, governmental program such as Medicare, CHAMPUS, and workers' compensation, which may be obligated to pay all or part of the medical costs of injury, disease, or disability of a recipient, unless any of these are excluded by department rule; and(15)(b) a spouse or a parent who:(15)(b)(i) may be obligated to pay all or part of the medical costs of a recipient under law or by court or administrative order; or(15)(b)(ii) has been ordered to maintain health, dental, or accident and health insurance to cover medical expenses of a spouse or dependent child by court or administrative order. See Utah Code 26B-3-1001(1)(a) Except as provided in Subsection (1)(c), if the department provides or becomes obligated to provide medical assistance to a recipient that a third-party is obligated to pay for, the department may recover the medical assistance directly from the third-party.(1)(b)(1)(b)(i) A claim under Subsection (1)(a) or Section 26B-3-1003 to recover medical assistance provided to a recipient is a lien against any proceeds payable to or on behalf of the recipient by the third-party.(1)(b)(ii) The lien described in Subsection (1)(b)(i) has priority over all other claims to the proceeds, except claims for attorney fees and costs authorized under Subsection 26B-3-1011(2)(c)(ii).(1)(c)(1)(c)(i) The department may not recover medical assistance under Subsection (1)(a) if:(1)(c)(i)(A) the third-party is obligated to pay the recipient for an injury to the recipient’s child that occurred while the child was in the physical custody of the child’s foster parent;(1)(c)(i)(B) the child’s injury is a physical or mental impairment that requires ongoing medical attention, or limits activities of daily living, for at least one year;(1)(c)(i)(C) the third-party’s payment to the recipient is placed in a trust, annuity, financial account, or other financial instrument for the benefit of the child; and(1)(c)(i)(D) the recipient makes reasonable efforts to mitigate any other medical assistance costs for the recipient to the state.(1)(c)(ii) The department is responsible for any repayment to the federal government related to the medical assistance the department is prohibited from recovering under Subsection (1)(c)(i).(2)(2)(a) The department shall mail or deliver written notice of the department’s claim or lien to the third-party at the third-party’s principal place of business or last-known address.(2)(b) The notice shall include:(2)(b)(i) the recipient’s name;(2)(b)(ii) the approximate date of illness or injury;(2)(b)(iii) a general description of the type of illness or injury; and(2)(b)(iv) if applicable, the general location where the injury is alleged to have occurred.(3) The department may commence an action on the department’s claim or lien in the department’s name, but the claim or lien is not enforceable as to a third-party unless:(3)(a) the third-party receives written notice of the department’s claim or lien before the third-party settles with the recipient; or(3)(b) the department has evidence that the third party had knowledge that the department provided or was obligated to provide medical assistance.(4) The department may:(4)(a) waive a claim or lien against a third party in whole or in part; or(4)(b) compromise, settle, or release a claim or lien.(5) An action commenced under this section does not bar an action by a recipient or a dependent of a recipient for loss or damage not included in the department’s action.(6) Except as provided in Subsection (1)(c), the department’s claim or lien on proceeds under this section is not affected by the transfer of the proceeds to a trust, annuity, financial account, or other financial instrument.