When an entity pays medical costs for injuries or illnesses that are later determined to have been caused by third parties, that entity is typically entitled to recover such expenses – either directly through “subrogation” claims, or indirectly through “reimbursement” claims.
Healthcare payers and plans typically pursue reimbursement of readily identifiable subrogation matters, including automobile and premises liability claims. However, most are missing opportunities to recover expenses paid due to illness or injury from dangerous pharmaceuticals, defective medical devices or harmful toxic substances. Medical expenses associated with these specialized claims are some of the most costly claims healthcare payers incur, since injuries related to these products are often severe and require extensive medical treatment.
When prescription drugs are defective or otherwise do not perform as intended, they can cause serious and potentially fatal injuries for their users. Medical costs attributed to prescription drug claims are enormous outlays which drain vital assets for healthcare payers and plans.
In recent years, a host of medical devices have proven to be dangerously defective shortly after introduction, including artificial hips, pain pumps and other medical devices. Medical expenses for treating the consequences of these defective devices and the resulting complications can easily be in the $50,000-$100,000 range or higher.
Medical expenses due to exposure to toxic substances, such asbestos-related diseases like mesothelioma and lung cancer, are typically in the $100,000-$200,000 range (due to the rapid progression of the disease after diagnosis). Medical expenses for debilitating long-term illnesses, including certain specific blood cancers caused by toxic substances requiring numerous treatments over many years, could easily be in the $400,000-$800,000 range and even $1,000,000 or higher.
Healthcare payers and plans allocate a significant amount of plan dollars to medical expenses attributed to defective medical devices, pharmaceuticals or chemical and toxic exposures. Undetected subrogation and reimbursement claims in these specialized areas could add up to millions of dollars in lost recovery opportunities.
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