Every year, significant amounts of money that are legally and rightfully due a company – funds that could have been directed to the bottom line – are lost through ineffective, inefficient or even inactive subrogation practices.
McAfee & Taft’s Subrogation Recovery Services is a skilled legal and claims recovery team dedicated to recovering healthcare medical claims paid primarily as a result of third-party liability. In cases where another person or entity (tortfeasor) is deemed to have been responsible for the injury that prompted the medical claim – usually the result of an auto accident, medical malpractice, product liability or other accident or act of negligence – we step in to enforce the rights of employers, third party administrators (TPAs), stop loss carriers, HMOs and self-insured plans who seek reimbursement of paid medical claims.
Recovery data analytics
Identifying any recovery opportunity begins with your claims data. Our proven technology and proprietary internal resources scrub your data using procedure codes (ICD-9, CPT) to indicate the broadest subset of claims that may have been the result of an accident. Our subrogation specialists then use this data to investigate and identify potential recovery opportunities.
The most common approach to investigation includes sending accident questionnaires to plan members whose claims have been identified as having recovery potential. While this approach can be effective, it relies on plan participant collaboration and honesty and often requires claim payer follow-up. Our proven technology combined with traditional recovery methods allow for greater recovery outcomes.
In the litigious environment in which we live, the greatest obstacle to plan recovery can be the plaintiff’s personal injury attorney. To avoid unnecessary losses, health plans cannot afford to go without their own legal representation.
There are many laws, both state and federal, that affect a plan’s right to recover. Two legal doctrines in particular pose a serious threat to a plan’s ability to recover 100% - the “common fund” and “make whole” doctrines. The right health plan language is critical to countering these threats, but documentation is only the beginning.
McAfee & Taft’s Subrogation Recovery Services team has more than 25 years experience representing employers, positioning health plan interests, and negotiating with personal injury lawyers, liable parties and adverse carriers.
McAfee & Taft’s Subrogation Recovery Services team can serve as an extension of your staff, becoming your subrogation department and delivering the recoveries and services expected by you and your group. Payment is made on a contingency basis, which means no out-of-pocket cost to you.
We believe the key to a successful recovery lies in the early detection of subrogatable cases.
Putting the involved members, insurance carriers and attorneys on notice early in the process both increases the bottom-dollar recovery and decreases misunderstandings among your members.
We are firmly dedicated to reducing waste, fraud and abuse that contribute to the overall cost of health care. Subrogation is a key cost containment strategy and critical for every health care payer. Our state-of-the-art claim detection and tracking system and an experienced staff of legal recovery professionals ensure the most successful outcomes.
The McAfee & Taft strategic recovery process
Phase I: identifying a potential third part accident claim
Our system filters and scrubs the claims based on a designated set of medical codes including all ICD-9 diagnosis codes, looking as far out as the sixth field of every claim. After mining the data, all claims with a matched filter code that have met or exceed the client-specified dollar threshold automatically generate an inquiry to the member.
Phase II: Research and investigation
Upon identification of a possible subrogatable case, our system automatically generates, prints and prepares for mailing the member injury questionnaire. Our follow-up questionnaire is automatically generated if a set number of days has gone by without a response from the member. Members may respond by returning the completed questionnaire by fax or by mail by using an addressed stamped envelope provided for their convenience. In many cases, police accident reports are ordered and utilized to obtain valuable accident-related details and information.
Phase III: Case management
Our case management platform offers a systematic approach to managing cases and member communications. Liens are generated within the system and then provided to the responsible third party. These liens are monitored and updated until a settlement is achieved. Personal contact is made with the attorneys and third party insurance carriers to gather information and provide updates on claim balances, as well as to ensure your subrogation rights are in place.
Phase IV: negotiations and settlement process
Our subrogation team negotiates the entire settlement process, from handling reduction requests to dealing with problems that may arise from an adverse attorney or insurance carrier. If a problem should surface that needs legal attention during this phase, one of our expert attorneys is readily available to help solve any disputes.
Phase V: Recovery and reporting
At McAfee & Taft, we recognize the need for prompt recovery and accurate reporting. You will receive reports on a regular basis which may be used for internal underwriting, financial and operational purposes. Upon recovery, we provide a detailed report which allocates all recovered claims and fees to the appropriate parties.
Subrogation recovery flow chart
Full-service recovery offerings
- Gathering of accident questionnaires and police reports
- Comprehensive plan language review and recommendations
- Electronic data mining, claims tracking and review
- Legal research and claims advice
- Stop loss negotiations
- Overpayment solutions and recovery strategies
- Expert legal advice
- Auto no fault
- Automobile insurance
- General liability
- Homeowner’s insurance
- Medical malpractice
- Negligent party
- Product liability
- Workers’ compensation
Subrogation services contacts