Who gets paid first from a Lewiston crash settlement?

Q: Who gets paid first from a Lewiston crash settlement?

In Idaho, many injury crash settlements fall around $15,000 to $75,000, while serious pedestrian or delivery-van cases can be much higher. Picture a common Lewiston situation: your employee is driving for work near 21st Street during spring thaw, hits a frost-heaved stretch, and a DoorDash driver slams into them. The case settles for $60,000. That does not mean your employee gets a check for $60,000. First, the settlement is split into the gross amount and the claims against it. If there is a lawyer, attorney fees and case costs usually come out early. Then the real issue is the medical money. If Medicare paid bills, Medicare usually has a reimbursement claim and expects to be paid back from the settlement. If Idaho Medicaid paid, the Idaho Department of Health and Welfare may also claim repayment from the injury recovery. If private health insurance paid, the insurer may assert subrogation or reimbursement rights. Whether they get paid depends a lot on the policy language, especially if it is an employer plan governed by ERISA. If the employee was hurt on the job, that adds another layer. In Idaho, the workers' compensation insurer or surety may have a lien against a recovery from the at-fault driver. The Idaho Industrial Commission is often where disputes about comp benefits and recovery issues show up. General rule: the pie usually gets divided in this order: Attorney fees and costs Medicare/Medicaid or valid insurance reimbursement claims Workers' comp lien, if the crash was work-related Any valid hospital or provider lien The injured person gets what is left Not every bill is a valid lien. A hospital demanding payment is not the same thing as a properly enforceable claim. Before money is distributed, the settlement sheet should identify who is claiming what, why, and under what law.

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Accepted Answer

In Idaho, many injury crash settlements fall around $15,000 to $75,000, while serious pedestrian or delivery-van cases can be much higher.

Picture a common Lewiston situation: your employee is driving for work near 21st Street during spring thaw, hits a frost-heaved stretch, and a DoorDash driver slams into them. The case settles for $60,000. That does not mean your employee gets a check for $60,000.

First, the settlement is split into the gross amount and the claims against it. If there is a lawyer, attorney fees and case costs usually come out early. Then the real issue is the medical money.

If Medicare paid bills, Medicare usually has a reimbursement claim and expects to be paid back from the settlement. If Idaho Medicaid paid, the Idaho Department of Health and Welfare may also claim repayment from the injury recovery.

If private health insurance paid, the insurer may assert subrogation or reimbursement rights. Whether they get paid depends a lot on the policy language, especially if it is an employer plan governed by ERISA.

If the employee was hurt on the job, that adds another layer. In Idaho, the workers' compensation insurer or surety may have a lien against a recovery from the at-fault driver. The Idaho Industrial Commission is often where disputes about comp benefits and recovery issues show up.

General rule: the pie usually gets divided in this order:

Attorney fees and costs
Medicare/Medicaid or valid insurance reimbursement claims
Workers' comp lien, if the crash was work-related
Any valid hospital or provider lien
The injured person gets what is left

Not every bill is a valid lien. A hospital demanding payment is not the same thing as a properly enforceable claim. Before money is distributed, the settlement sheet should identify who is claiming what, why, and under what law.