Subrogation and Reimbursement
What is Subrogation and Reimbursement?
Subrogation refers to TeamCare's right to recover 100% of benefit payments made by us for any physical or mental condition or injury that was or may have been caused by any person. The process to get the other party to reimburse us is called Subrogation.
Will TeamCare pay medical expenses if I or a family member was injured in an automobile accident?
TeamCare may provide benefits for illness, injury, and/or disability related to an accident or injury, however, TeamCare's right to 100% reimbursement applies when there may be other sources of recovery. Refer to your Summary Plan Description under Plan Documents for detailed information.
How much is TeamCare entitled to receive from my settlement or other recovery?
TeamCare is entitled to full reimbursement from your settlement or any other recovery of 100% of its benefit payments. That full reimbursement is not reduced by attorneys’ fees and other costs you incur in obtaining your settlement or other recovery. However, TeamCare may consider settlement and compromise on the amount owed in appropriate cases.
I received a letter from an attorney stating he represents TeamCare. Is this legitimate?
Yes. The letter is legitimate if it is from TeamCare's Law Department, Coghlan Law LLC, or Healthcare Recovery Solutions (HRS). TeamCare utilizes all three of these entities to pursue its Subrogation rights. Please respond to their request. Refer to your Summary Plan Description under Plan Documents for detailed information.
I lost the letter I received from the TeamCare attorney. Whom do I contact about my case?
You, or your attorney if you are represented by one, can call the TeamCare Subrogation Line at 847-777-4060, Coghlan Law LLC at 800-627-3360, or HRS at 855-201-1565 depending on who sent you the communication.
Why does TeamCare need this information?
Your health plan contains an important clause called Subrogation or Reimbursement. This means when TeamCare pays medical bills for an injury or illness that has been caused by a third party, we have a right to seek reimbursement of those medical bills from the third party, their insurance company, and/or your insurance company. We also have the right to seek reimbursement of the medical bills from you if you receive a settlement from the third party or an insurance company for this injury or illness. A portion of your recovery in any such proceeding is meant to cover these medical bills and/or disability payments made by TeamCare.
How does TeamCare identify your claim as a potential Subrogation case?
We have established a list of diagnosis codes that indicate an injury or illness, which may be accident related or work related. When claims are processed through our system, a questionnaire is generated if the patient has received treatment for an injury or illness that has one of these accident-type diagnosis codes.
How does Subrogation help me?
These Subrogation procedures help to contain the cost of healthcare by reducing premium costs paid by you and/or your employer, and also reducing the amount of benefits applied to your lifetime maximum benefit amount.
What if I was injured on the job?
Your health plan also contains a provision that excludes the payment of medical bills for work-related injuries and illnesses. This means that we will not provide benefits if workers’ compensation laws cover, provide or pay for the service, supply or treatment of any work-related accident or illness. In addition, if you receive a settlement for your workers’ compensation claim, we consider the settlement payment to be covered by workers’ compensation and we will not provide medical benefits for the injury or illness. TeamCare may agree to enter into an agreement to reimburse you and your attorney pursuant to which we will provide coverage for your work-related injuries.
Does this questionnaire only apply to work-related accidents?
No. If another person caused your injury or illness or may be responsible for your injury or illness, whether this is through a vehicular accident, a slip and fall, premises or even medical malpractice, you need to complete this form. If you were injured on the job, please indicate so when describing your injury.
What if this claim was not accident related, or if no one else was responsible for the injury or illness?
The only way we will know if your claims are or are not accident related is if you complete and return the Subrogation Questionnaire. After we receive your information indicating this was an illness for which no one else is responsible, we will make sure your claims are opened for processing and we will notate your information in our system to try to avoid having future questionnaires sent to you for the same incident.
What do I need to do?
It is very important that you complete the Subrogation Questionnaire and send it back to us. Your answers will help us properly administer your claims and determine if we need to seek reimbursement from a third party or an insurance company for these claims. If you do not return the report, we may suspend your medical benefits.
The Subrogation/Reimbursement and workers’ compensation clauses in your health plan require you to notify us if you receive an award or settlement from a third party or an insurance company. From that award or settlement, you must reimburse TeamCare for any medical benefits that we have paid for this injury or illness.
What if you still have questions or need help completing the Subrogation Questionnaire?
Contact us at 847-777-4060. Please have your TM file number ready. Your TM file number can be found in Section 1 on the Subrogation Questionnaire.