In my individual case, can I challenge or appeal Medicare's lien?



If you have an individual personal injury claim and are a Medicare beneficiary, you have the right to appeal Medicare's lien amount. Any appeal request must be made in writing on special forms. Appeal decisions are generally based on the financial hardship that repayment would cause the plaintiff/beneficiary. Types of financial hardship include the impact of unforeseen severe financial circumstances plus your ability to pay for out-of-pocket medical expenses not covered by Medicare. In order to help Medicare officials determine whether an appeal is needed, a “waiver” form is sent to the beneficiary, which asks for information on monthly income and expenses.

Additionally, Medicare beneficiaries have the option to seek a compromise of Medicare’s lien amount, either before or after they settle their case. The process is known as a pre- or or post- settlement compromise, depending on when you ask for it. A request for a compromise must be in writing and include:

  1. The amount that you want Medicare to accept in satisfaction of the lien; and
  2. A compelling story as to why the compromise should be granted.

You will also need to send documents that support your request. (The documents you need to provide will vary depending on whether you are submitting a pre- or post-settlement compromise.) Each matter is considered on a case-by-case basis. Whether a compromise is granted depends on a number of factors including your inability to pay the lien. If you reach an agreement with Medicare on a compromised amount to satisfy Medicare’s lien, you will not have another chance to appeal the lien. Before you decide to seek a compromise, you and your attorney should carefully review the facts and circumstances of your case to determine the best path to challenge the lien amount. The Garretson Resolution Group can help with this analysis and determine which route will yield the best result.