Liability, No-Fault and Workers’ Compensation Reporting
If you have Medicare and other insurance coverage, each type of coverage is called a “payer.” When there’s more than one potential payer, there are coordination rules to decide who pays first. The first or “primary payer” pays what it owes on your bills, and then the remainder of the bill is sent to the second or “secondary payer.” In some cases, there may also be a third payer.
Medicare may pay secondary to no-fault insurance, liability insurance or workers’ compensation. Please see the “No-Fault and Liability Insurance” and “Workers’ Compensation” sections below for additional information. To ensure correct payment of your Medicare claims, you should contact the Benefits Coordination & Recovery Center (BCRC) if you:
- Take legal action or an attorney takes legal action on your behalf for a medical claim,
- Are involved in an automobile accident, or
- Are involved in a workers' compensation case.
Reporting a Case
Always contact the BCRC first whenever you have a pending Liability, No-Fault, or Workers’ Compensation case. Click the Contacts link for BCRC contact information. When contacting the BCRC to report a case, have the following information available:
Medicare Beneficiary Information:
- Full Name
- Medicare Health Insurance Claim Number (HICN)
- Gender and Date of Birth
- Complete Address and Phone Number
- Type of Claim (Liability Insurance, No-Fault Insurance, Workers’ Compensation).
- Insurer or Workers’ Compensation Name and Address.
- Description of Alleged Injury, Illness or Harm.
- Date of Injury/Accident, or Date of First Exposure, Ingestion or Implant.
Note: When reporting a potential liability settlement, judgment, award, or other payment related to exposure, ingestion, or implantation, the date of first exposure/date of first ingestion/date of implantation is the date that MUST be reported. For further details regarding this topic, please refer to the document titled, Liability Insurance (Including Self-Insurance): Exposure, Ingestion, and Implantation issues and December 5, 1980, located in the Downloads section near the bottom of this page.
Attorney Information (if applicable):
- Attorney or Law Firm Name
- Complete Address and Phone Number
After the case has been reported, the BCRC will apply the information to Medicare’s record. If it is determined that the beneficiary should reimburse Medicare, the BCRC will begin the process for recovering money owed to Medicare. See the Medicare’s Recovery Process page for more information.
No-Fault and Liability Insurance
No-fault insurance is insurance that pays for health care services resulting from injury to an individual or damage to property in an accident, regardless of who is at fault for causing the accident. No-fault insurance may be found as part of:
- Automobile insurance policies
- Homeowners’ insurance policies
- Commercial insurance plans
- Medical Payments Coverage/Personal Injury Protection/Medical Expense Coverage
Liability insurance (including self-insurance) is coverage that protects the policyholder or self-insured entity against claims based on negligence, inappropriate action, or inaction that results in bodily injury or damage to property. Liability insurance includes, but is not limited to, the following:
- Homeowners’ liability insurance
- Automobile liability insurance
- Product liability insurance
- Malpractice liability insurance
- Uninsured motorist liability insurance
- Underinsured motorist liability insurance
A workers’ compensation law or plan means a law or program administered by a state (defined to include commonwealths, territories and possessions of the United States) or the United States to provide compensation to workers for work-related injuries and/or illnesses. The term includes a similar compensation plan established by an employer that is funded by such employer directly or indirectly through an insurer, to provide compensation to a worker of such employer for a work-related injury or illness. Workers’ compensation is a law or plan that compensates employees who get sick or injured on the job. Most employees are covered under workers’ compensation plans.
As part of a workers’ compensation settlement, funds may be set aside to pay for future medical and prescription drug expenses related to the injury, illness, or disease that would normally be covered by Medicare. These funds are deposited into a Workers’ Compensation Set-Aside Agreement (WCMSA). For more information on this topic, please select the WCMSA link.
For more information on how Medicare works with other insurance, click the Medicare.gov link. Next, go to the “Supplements and Other Insurance” menu option at the top of the page and select “How Medicare works with other insurance” from the drop-down list. Additionally, you may access information by clicking the Non-Group Health Plan Recovery link.
- Alert- 2015 Recovery Threshold for Certain Liability Settlements, Judgments, Awards or Other Payments [PDF, 55KB]
- Computation of Annual Liability Insurance (Including Self-Insurance) Settlement Recovery Threshold- 2015 [PDF, 69KB]
- Liability Insurance (Including Self-Insurance): Exposure, Ingestion, and Implantation issues and December 5, 1980 [PDF, 244KB]
- Page last Modified: 12/08/2015 10:18 AM
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