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COMAR 10.09.24.15

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State of Maryland Medical Assistance Manual Revised July 2012 for which the other party was responsible. In any case where a third party may be liable for medical expenses, complete an 1169 reporting such a situation to the Division of Recoveries.

Liability cases may involve personal injuries resulting from automobile accidents, malpractice suits, lead paint poisonings, or accidental injuries sustained on the premises of another individual. The Legal Liabilities Section will contact the recipient, his attorney, and the insurance company to request reimbursement from any settlement funds. The amount of reimbursement requested will not exceed the amount of the accident related services paid by the MA Program.

Workmen‟s Compensation cases are a specialized type of Liability case in which an injury has occurred as a result of the person‟s job or at his place of employment. If the MA Program has paid for the cost of treatment for any work related injuries, the Legal Liabilities Section will seek to recover the pertinent costs from the Workmen‟s Compensation insurance carrier or the self- insured employer.

If a recipient has been criminally assaulted by another person, the Legal Liabilities Section will attempt to recover for the Program the cost of all assault related treatment from the involved third party, i.e., the defendant.

The LDSS must report any cases involving legal liability, lawsuits, paternity, support orders, Workmen‟s Compensation, assault or accidental injuries to the Division of Recoveries via the DHMH 1169. It is essential to supply complete and accurate information on the 1169, and it is the responsibility of the A/R to provide this information to the LDSS. The cases involving lawsuits and potential settlements must be flagged for review as appropriate, and the results of the review reported to the Division of Recoveries.

1500.5 Estates

The Division of Recoveries will pursue recovery from the estates of decreased recipients when legally possible. Recovery is usually pursued by filing a claim against the open estate of the decreased. For MA recipients, the Division of Recoveries will seek to recover all payments made on behalf of the recipient after the recipient became age 65, unless the recipient is survived by:

A spouse (even if separated); A unmarried child under 21; or A blind or disabled child of any age.

The Division may waive its right to recover in “hardship” cases.

If there are recoverable resources, the LDSS must refer the case to the Division of Recoveries via Form 1169. Recoverable resources include the $2,500 resources limit or any portion, thereof for an individual‟s if left in an estate and not used for other purposes. If is not