Section 5G Claimant; subrogation
Section 5G. As used in this section, the following words shall have the following meanings:—
“Claimant”, any person who suffers any loss from property damage, accident, illness, injury or otherwise for which monies may be provided by liability insurance, workers’ compensation, or any other third party.
“Third party”, any individual, agency, program, entity or insurer, including but not limited to the claimant’s own insurer, that is or may be liable to pay monies on account of the claimant’s loss.
“Date of the loss”, the date on which the property damage, accident, illness, injury, or other incident occurs.
When any claimant or the claimant’s heirs, estate or legal representative receives payment from a liability or workers’ compensation insurer or any other third party, the claimant or the claimant’s heirs, estate or legal representative shall repay to the department and the division of medical assistance the total of all public assistance benefits, both financial and medical, provided by said agencies on or after the date of the loss to or on behalf of the claimant, the claimant’s spouse or children, and any other individual the claimant is required by law to support; provided, however, that on the date of the loss the claimant was already eligible for medical assistance benefits, the claimant or the claimant’s heirs, estate or legal representative shall repay only medical assistance required and any increase in financial assistance that occurred as a result of the accident, illness, injury, or other incident.
The application for and receipt of benefits recoverable under this section shall, after notice to the third party, operate as a lien to secure repayment against monies which may be provided by said third party up to the amount of such benefits. Notwithstanding the foregoing, the department and the division of medical assistance may also perfect their right to a lien against any monies which may come into possession of the claimant’s attorney by giving notice to said attorney.
If the monies available for repayment are insufficient to satisfy in full any competing claims of both the department and the division of medical assistance, the department and the division shall each be entitled to its respective pro rata share of such monies as are available.
Any person receiving public assistance benefits recoverable under this section shall assign to the commonwealth an amount equal to the benefits so provided from the proceeds of any such claim against the third party.
A claimant shall, within ten calendar days, notify the department in writing upon commencement of a civil action or other proceeding to establish the liability of any third party or to collect monies payable under accident, liability, or health insurance, workers’ compensation, or from any other third party or source.
The commonwealth shall be subrogated to a claimant’s entire cause of action or right to proceed against any third party and to a claimant’s claim for monies to the extent of assistance provided under chapters one hundred and seventeen, one hundred and eighteen, or one hundred and eighteen E. The commonwealth shall also have a separate and independent cause of action to recover, from any third party, assistance provided to a claimant under said chapters, which cause of action shall be in addition to other causes of action. The commonwealth may, by attorneys employed or selected by it, commence a civil action or other proceeding to establish the liability of any third party or to collect such moneys, or may intervene as of right in any civil action commenced by a claimant against a third party. No third party shall require written authorization from the claimant before honoring the commonwealth’s rights under this section.
Failure of a claimant without good cause to provide notice as required under this section or to provide such further information deemed necessary by the department to pursue its rights under this section shall be grounds for termination of benefits. Notwithstanding any general or special law or rule or regulation to the contrary, an insurer doing business in the commonwealth shall provide information requested by the department of transitional assistance and the division of medical assistance for use by the agencies for the purpose of recovering public assistance benefits under this section and section 22 of chapter 118E.