Sec. 38a-472. (Formerly Sec. 38-174a). Assignment of insurance proceeds to doctor, hospital or state agency. Lien for state care. Notice of lien.
Sec. 38a-472. (Formerly Sec. 38-174a). Assignment of insurance proceeds to
doctor, hospital or state agency. Lien for state care. Notice of lien. (a) Whenever a
contract by a third party agency provides for payment to a beneficiary under the contract
on account of bills incurred by him for medical, surgical or hospital care received by
him, the assignment of the benefits of the contract by that beneficiary to the department
head, as defined in section 4-5, of a state agency, or any doctor or hospital rendering
such care, when sent by registered or certified mail to the third party agency, with a
copy to the insured, shall be authority for the payment directly by the third party agency
to the assignee. The state shall have a lien, in an amount equal to the care rendered, on
the proceeds of such contracts for care rendered by any state hospital, institution or other
facility, written notice of which shall be authority for the payment directly by the third
party agency to the state.
(b) Whenever there is in existence a contract by an insurer for payment to, or on
behalf of, an applicant or recipient of medical assistance under the state-administered
general assistance program or the Medicaid program under said contract on account of
bills incurred by the applicant or recipient for medical services, including, but not limited
to, physician services, nursing services, pharmaceutical services, surgical care and hospital care, the assignment of the benefits of the contract by such applicant or recipient
or his legally liable relative pursuant to section 17b-265 shall, upon receipt of notice
from the assignee, be authority for payment by the insurer directly to the assignee. If
notice is provided by the assignee to the insurer in accordance with the provisions of
section 17b-265, the insurer shall be liable to the assignee for any amount payable to
the assignee under the contract.
(c) No insurer, health care center or issuer of any service plan contract for hospital
or medical expense coverage delivered, issued for delivery or renewed in this state shall
impose requirements on the Department of Social Services which have the effect of
denying or limiting benefits which have been assigned pursuant to this section. The
assignment of benefits shall be in accordance with the provisions of section 38a-472.
(1961, P.A. 124; P.A. 75-591; P.A. 90-243, S. 70; 90-283, S. 2; May Sp. Sess. P.A. 94-5, S. 8, 30; June 18 Sp. Sess.
P.A. 97-2, S. 101, 165; P.A. 04-76, S. 36.)
History: P.A. 75-591 clarified existing provision by substituting "sent by registered or certified mail" for "lodged with",
authorized assignment of benefits to department heads, required a copy to be sent to insured and added provision re state's
lien on contracts for care rendered by state hospitals, institutions, etc.; P.A. 90-243 made technical changes for statutory
consistency; P.A. 90-283 added Subsec. (b) re assignment of benefits of contract by an applicant or recipient of medical
assistance; Sec. 38-174a transferred to Sec. 38a-472 in 1991; May Sp. Sess. P.A. 94-5 added a new Subsec. (c) to prevent
insurers from imposing requirements on the department of social services which deny or limit benefits assigned pursuant
to this section, effective July 1, 1994; June 18 Sp. Sess. P.A. 97-2 amended Subsec. (b) to make technical and conforming
changes to references re assistance programs, effective July 1, 1997; P.A. 04-76 amended Subsec. (b) by deleting reference
to "general assistance program".
Annotation to former section 38-174a:
Subsec. (b):
Cited. 219 C. 439.
Annotation to present section:
Cited. 219 C. 439.