United States Personal Injury Claims - Medicare Reporting

United States Personal Injury Claims – Medicare Reporting

A new law came into force in the United States of America on 1 July 2009 which requires reporting by or on behalf of shipowners or operators of sickness or injury, including the costs of medical care for which they are liable, to people who are eligible to receive or receiving Medicare benefits at the date of the sickness or injury. Such people could include seafarers, harbour workers and vessel’s passengers. The new law is contained in the Medicare, Medicaid and SCHIP Extension Act 2007 (“MMSEA”) and particularly Section 111 of that Act.

Medicare is a long established US Government health insurance program which pays for hospital and other medical treatment as well as prescription drug costs for US citizens or residents who are aged 65 and above, or who have certain disabilities or who are suffering end-stage renal disease (permanent kidney failure requiring dialysis or a transplant). In order to receive payment of Medicare benefits these people must first have pursued their rights of recovery of medical expenses from workers compensation schemes or no fault or liability based insurance plans (including self insured plans).

Section 111 of MMSEA now requires reporting on behalf of insurance plans, including liability insurance, of sickness or injury to such people. Detailed reports about such sickness or injury must be made to the Center for Medicare and Medical Services by the Responsible Reporting Entity (“RRE”). The RRE is required to register with the Center in order to report the sickness or injury and failure to report may result in the imposition of a fine of up to $1,000 per day until a report is made. Any fine imposed in respect of reporting is covered only at the Club’s discretion.

Normally the RRE is the insurer rather than the insured, but because of the indemnity nature of P & I cover, it is understood that the Member, in connection with the operation of whose vessel the sickness or injury occurred, will be regarded as the RRE for the purposes of any reporting of sickness and personal injury which may be subject to MMSEA.

This new legislation will mainly affect  Members based and operating in the United States and employing US crew, but owners, charterers and operators of cruise ships carrying US passengers worldwide or of other vessels regularly calling at US ports are also likely to be significantly affected. Such Members are likely to need to report frequently and hence will probably wish to register by 30 September 2009 – the advance registration date set by the Center for Medicare and Medical Services - so that they will be able to submit their reports in a timely manner. We are sending separate more detailed advice to them about both registration and reporting.

However, any Member with a vessel calling at US ports or carrying a US citizen or resident may be affected by the new law. It is important therefore that, if it is thought that an injury or sickness has been suffered in connection with the operation of an entered vessel by a person who might be eligible for Medicare benefits, the Club is notified as soon as possible, so that the necessary report can be made to the Center for Medicare and Medical Services together with registration as required.

If further details are required, please do not hesitate to contact the Managers.