Subrogation Checklist for Injury Cases

I recently asked a very important question on my Instagram stories (@ParalegalCoach_Misty) because I wanted to ask the burning question that all freelance paralegals really want to know, which is:

"What is the #1 task you outsource."

Amongst the many answers provided in my poll was the daunting task of obtaining, auditing, disputing, and finalizing subrogation liens. In fact, when it comes to Medicare, several firms outsource this task altogether by using big companies like Synergy and Epiq (formerly Garretson). However, as technology evolves and large insurance companies evolve with it, the doors begin to slowly open for freelance paralegals to broaden their horizons into lien handling as a service-based product. However, even if you're reading this article as an in-house paralegal, chances are, the task of obtaining and tracking liens usually falls on you.

In case you're wondering, and to get truly technical for just a moment, subrogation is:

"The assumption by a third-party of another party's legal right to collect a debt or damages."

In a nutshell, if your client is receiving money for damages incurred from a case for which his/her healthcare insurance (or any other insurance) paid a bill, including a hospital stay, clinic visit, ambulance ride, etc., then the insurance company is entitle to reimbursement.

The process is tedious and could take as little as 180 days or as much as several years, depending on the claim or case. Nevertheless, the attorneys like to outsource this process, which potentially opens up a line of new service-based products offered by freelance paralegals. If you're an in house paralegal dealing with subrogation or if you're a freelance paralegal looking to add this to your services, here are 7 steps you can take to obtaining, negotiating, and finalizing those pesky subrogation liens.

1. Get A Handle On It

You need to identify and prepare an index of potential lienholders, including contact info, policy identifiers, and the type of plan that may be collecting - Medicare/Medicaid, Workers' Comp, ERISA, Advantage, etc. You'll expand on this index as we move along in this checklist.

Of course, I have a liens index already prepared for you, which you can download from my website at

Now that you've got a handle on what sort of liens may exist, we start step 2.

2. Have A Discussion With The Plaintiff/Client

The Plaintiff needs to be made aware of what liens may require reimbursement from any settlement or recovery he/she may receive. If you're reporting to Medicare, keep in mind that when you receive documents in the mail from Medicare, so does your client. Avoid blindsiding the Plaintiff with paperwork received from Medicare by letting the Plaintiff know in advance. This will help to ward-off unwanted and unnecessary telephone calls. Medicare is the only lienholder that will directly communicate with the beneficiary (or insured) once you've sent out a letter of representation, which takes me to the next step.

3. Prepare Letters of Representation

Prepare a letter to each potential lienholder identifying yourself, the beneficiary (or insured's) name, address, date of birth, last 4 of the SSN, if applicable, the HICN number (which is a Medicare beneficiary's ID number), date of loss, date of death (if applicable), and policy/group info. If you're dealing with Medicare (also known as CMS) as a lienholder, you've got some additional steps. Medicare also requires that you identify the beneficiary&#