OLR Bill Analysis
HB 6221 (as amended by House "A")*
AN ACT CONCERNING RECOVERY OF PAYMENTS FROM COLLATERAL SOURCES BY A MUNICIPALITY WITH A SELF-INSURED HEALTH PLAN.
This bill gives self-insured towns, cities, and boroughs (“municipalities”) a lien on the part of certain judgments or settlements to an employee or his or her covered dependent or family member (“insureds”) for medical, hospital, and prescription expenses incurred due to a third party's negligence or recklessness. The lien only applies to certain types of “tortfeasor recoveries” and instances when a municipality incurs more than $15,000 in medical, hospital, and prescription expenses.
With some exceptions, current law prohibits insurers and others providing health benefits from recovering the cost of such benefits from a defendant or anyone else as a result of a personal injury or wrongful death suit or action, regardless of whether it is resolved by settlement or judgment (CGS § 52-225c).
*House Amendment “A” replaces the underlying bill with provisions that also authorize self-insured municipalities to recover the cost of health expenses incurred on behalf of insureds, under certain circumstances.
EFFECTIVE DATE: October 1, 2017
Under the bill, a municipality is “self-insured” if it provides group health benefits to its employees by paying submitted medical, hospital, and prescription expense claims from its revenues.
A “tortfeasor recovery” that may be subject to a lien is moneys paid by or on behalf of the person or entity whose negligence or recklessness caused the injuries for which medical, hospital, and prescription expenses were incurred. It includes recoveries from wrongful death suits alleging negligence or recklessness and claims alleging the negligent operation of a state-owned motor vehicle. But it excludes recoveries based on torts other than negligence or recklessness, including those related to causes of action based on state statute, intentional misconduct, and uninsured or underinsured motorist claims.
Right to Recover Expenses. For a lien to be effective under the bill, a municipality must provide written notice of it to the insured or his or her counsel before settlement or a judgement's entry. A municipality can meet this notice requirement by including clear language in conspicuous bold face font in its group health plan coverage booklet notifying insureds that they must reimburse the municipality from a tortfeasor recovery for any medical, hospital, and prescription expenses incurred due to a third party's negligence.
Amount Claimed. Under the bill, if the insured or his or her attorney makes a written request to the municipality after settlement or a judgment's entry, the municipality must disclose within 30 days the total amount of the lien claimed. If a municipality does not provide this information in a timely manner, it waives the lien and has no further right to claim a portion of the tortfeasor recovery as reimbursement for medical, hospital, and prescription expenses incurred.
CALCULATING THE LIEN AMOUNT
The bill limits a lien's amount to the medical, hospital, and prescription expenses incurred at the time of settlement or judgement. The amount must be further reduced by:
1. the percentage of comparative negligence attributed to the municipal employee under the statute concerning negligence liability in cases where there are multiple tortfeasors;
2. the percentage ratio that the employee's legal fees and costs bear to the total judgement or settlement; and
3. application of equitable defenses, including the make whole doctrine and unjust enrichment.
Under the bill, if the parties cannot agree on the application of equitable defenses, the insured or municipality may petition the superior court for assistance in resolving the issue. Such a petition is privileged with regard to hearing assignment and must be heard by a superior court judge within 30 days of the petition's filing.
The bill specifies that the right to a lien does not extend to commercial insurance companies that provide health insurance benefits to municipal employees and their dependents and family members, including stop loss insurance. Similarly, self-insured municipalities cannot recover medical expenses paid from an insured plan, whether fully or partially insured.
SB 885 (File 709), reported favorably by the Judiciary Committee, contains a related provision.
Planning and Development Committee