Third-Party Liability / Subrogation

Subrogation means that your health insurance company can ask to be paid back if they paid for your medical care and someone else was responsible for the injury or illness. For example, if you were hurt in a car accident and your insurance paid your bills, they might ask the car insurance company of the person who caused the accident to pay them back.

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Health Share members get care from one of the Plan Partners: CareOregon, Kaiser Permanente, PacificSource Legacy, OHSU, and Providence. If you get hurt by someone else and get care from your plan, they can ask to be paid back for those costs.

Only the plan who gave you care can ask for and accept this payment.  This is called a lien. If you do not know what plan you have, Health Share can help you.

 

Do you have questions about Subrogation?

Email Health Share:  Subrogation@healthshareoregon.org

Are you a member?

If you have an attorney, they can do the report for you. You must report your third-party injury to Personal Injury Liens or PIL online at www.reportinjury.org.

Don’t know if you need to report an injury? Don’t know how to start the process

You can email Health Share for help:  Subrogation@healthshareoregon.org

Oregon Health Plan requires members to report an injury caused by someone else to the Personal Injury Liens department at the Oregon Department of Human Services.

Are You an Attorney, or Insurance Agent?

Please send a Letter of Representation to Health Share and include:

  • Type of injury

  • Name and Address of who hurt the Member

  • Any liability or no-fault insurance and claim number

  • Attorney(s) information

  • Member’s employer, if worker’s compensation

  • Member name

  • Member date of Birth

  • Member ID (if known)

  • Date of Loss/Injury

  • The cause of injury

Lawyers must tell Oregon Department of Health Services PIL (Personal Injury Leins) about anyone else who might be responsible for paying for the member’s care within 30 days of finding out.

Oregon Health Plan Subrogation Process

  1. You, or your attorney, completes the PIL (Personal Injury Leins) online report.

  2. Your, or your attorney, sends the information about your injury to Health Share.

  3. Health Share will help you notify your Plan.

  4. Your Plan will let you or your attorney know if there are costs that need to be paid back.

  5. Oregon Department of Health Services PIL department will also let you know if they covered any costs related to your injury.

  6. The PIL department will ask for those costs to be paid back.

  7. Your plan can’t accept any payments until PIL has agreed that all costs are included.

  8. This process can take months.