The short answer
Health insurers, medical providers, and public benefit programs may hold rights to be repaid out of an injury recovery. Where Medicare paid, federal rules require a pending liability case to be reported and conditional payments to be repaid when a settlement, judgment, award, or other payment is made.
Your reading roadmap
01
Why anyone has a claim on your recovery
When someone else caused an injury, the party responsible is expected to bear the medical cost. Where a health plan or a public program paid in the meantime, it generally paid on the understanding that it would be repaid if a recovery followed. That is the logic underneath every lien and reimbursement claim, and it is why the issue arrives at the end rather than the beginning.
02
Medicare conditional payments
The Centers for Medicare and Medicaid Services describe a conditional payment as one Medicare makes where a primary plan is not expected to pay promptly, conditioned on reimbursement when the primary plan does pay — conditional precisely because it must be repaid when a settlement, judgment, award, or other payment is made. A pending liability, no-fault, or workers' compensation case must be reported to the Benefits Coordination and Recovery Center, which is the first step in the recovery process.
- Ask early who may hold a reimbursement right in your case
- Report a pending case where Medicare is involved
- Keep every explanation-of-benefits statement
- Ask whether lien resolution is inside your lawyer's fee
- Ask for the net figure in writing before agreeing to anything
- Do not assume an amount claimed is the amount finally owed
03
Private plans, providers, and programs
Beyond Medicare, an employer health plan, a private insurer, a hospital, or a state program may assert a right to be repaid. Whether the right exists, how strong it is, and whether the amount can be reduced depend on the type of payer, the plan terms, and state law. This variation is why a general answer is unhelpful and a specific one requires someone to look at the actual plan.
04
Why the amount claimed is often not the amount paid
Initial demands frequently include treatment unrelated to the incident, and reductions are commonly available depending on the payer and the circumstances. Resolution work is a real part of a case, and it happens after agreement — which is why a claimant can be told a figure and then wait while it is negotiated down.
05
How this changes what an offer is worth
A gross number means little until fees, case costs, and reimbursement rights are subtracted. A larger gross with a substantial lien attached can leave less than a smaller one without. Asking for the arithmetic in writing — gross, costs, fee, third-party claims, net — is the only way to compare two offers honestly.
06
Where this goes wrong
Settling without identifying who may claim reimbursement, spending the proceeds before resolution, or assuming that because nobody mentioned it, nobody will. Reimbursement rights do not lapse because a claimant was unaware of them, and discovering one after the money is gone is the worst version of this problem.
07
The questions to ask before you agree
Who may have a right to be repaid here, has that been confirmed with each of them, what is the current claimed amount, is a reduction likely, who handles the negotiation, and is that work inside the fee I am paying. Those six questions cover the whole issue and are entirely ordinary to ask.
FAQ
Frequently asked questions
Can I just not tell anyone about the settlement?
No, and where Medicare is involved federal rules require a pending liability case to be reported, with recovery pursued when a payment is made. Beyond the legal exposure, concealment tends to surface later and in a worse posture. This is an issue to resolve openly, with help, rather than to avoid.
Can the amount be reduced?
Often, depending on the payer type, the plan terms, and the circumstances, and it usually requires someone to negotiate rather than to simply pay the first demand. What is available differs substantially between Medicare, an employer plan, a private insurer, and a provider, which is why the payer type is the first thing to establish.
Does my lawyer handle this, or do I?
Ask specifically, because practice differs and the work is substantial. In some engagements lien resolution is inside the fee; in others it is separate or falls to the client. Establishing that before signing avoids an unwelcome discovery at exactly the point the case should be finishing.
Official forms and preparation tools
Get organized before you file or ask for help.
Use the preparation aids to collect information. Always obtain legal forms from the court or agency that controls them.
timelineInjury incident timeline
Fixes the sequence of events while memory is fresh, in the form a lawyer or adjuster can actually use.
Open checklist
How to use it
- Write it within days if you can; memory reshapes quickly
- Keep it factual and avoid characterising fault
- Mark where a record exists and where you are relying on memory
- Date the document itself, and do not rewrite it later
Before the incident
- What you were doing and where you were going
- Conditions — light, weather, surface, noise
- Anything you noticed that seemed unsafe
- Any prior injury to the same part of your body
The incident itself
- Date and time, as precisely as you can
- Exact location, including which entrance, aisle, or lane
- What happened, in sequence
- What was said at the scene, and by whom
- Who was present, with contact details
Immediately afterwards
- Who was notified, and when
- Report or claim numbers issued
- Whether photographs were taken, and by whom
- What was moved, cleaned, or repaired, and when
- First symptoms, and when they appeared
The days that followed
- First medical visit and what was said
- Work missed, and when it began
- Contact from any insurer, with names and dates
- Anything you signed or agreed to
This is preparation, not a statement to any insurer or court
It does not establish fault or the value of any claim
Completing it does not preserve any filing deadline
It is not legal advice and creates no attorney-client relationship
logInjury evidence log
Records what evidence exists, where it is, and what is at risk of disappearing before anyone requests it.
Open checklist
How to use it
- List what exists before worrying about what it proves
- Flag anything on a short retention cycle, especially video
- Note who controls each item, not only what it is
- Do not alter, clean, repair, or discard anything relevant
Physical evidence
- Anything involved in the incident, kept unaltered
- Damaged clothing, footwear, glasses, or equipment
- Vehicle or property damage, and where it is now
- Where each item is stored, and who has access
Images and recordings
Video retention cycles are frequently measured in days. Identify who controls footage first.
- Your own photographs and video, with original timestamps
- Photographs taken by anyone else, and who has them
- Nearby cameras — business, doorbell, transit, traffic
- Who controls each camera, and whether they have been asked
People
- Witnesses, with phone numbers and how to reach them
- Anyone who arrived afterwards and saw the conditions
- Staff or officials who responded
- Anyone who saw your condition in the days that followed
Documents
- Incident, police, or store reports and their numbers
- Correspondence from any insurer, with claim numbers
- Anything you have signed, with a copy retained
- Repair estimates, invoices, or property valuations
Listing evidence does not preserve it; some items require a formal request
It does not determine what is admissible or what matters legally
It does not preserve any filing deadline
It is not legal advice
logMedical treatment and expense log
Tracks treatment, costs, and missed work as they happen, so losses are documented rather than reconstructed.
Open checklist
How to use it
- Update it weekly; reconstruction months later is incomplete
- Record what was billed, what insurance allowed, and what you paid
- Note the reason for any gap in treatment at the time it happens
- Keep receipts even after a reimbursement
Providers and visits
- Provider name, specialty, and contact details
- Date of each visit and what it was for
- Diagnosis or findings as explained to you
- Referrals, imaging, and therapy ordered
- Whether records have been requested, and when
Costs
- Provider bills, with dates and amounts billed
- Explanation-of-benefits statements showing allowed and paid amounts
- What you paid out of pocket, with receipts
- Prescriptions, equipment, and supplies
- Travel, parking, and childcare for appointments
Work and income
- Dates missed, and whether paid or unpaid
- Sick leave or vacation used
- Employer confirmation obtained, and from whom
- Duties you could not perform on return
Daily effect
Specifics carry weight; adjectives do not. Record the shift you could not work, not how bad it felt.
- A line or two per day: what hurt, what you could not do
- Specific activities missed, with dates
- Help you needed that you would not normally need
- Any reason you missed or stopped treatment
This is a private record, not a medical record or a claim submission
It does not establish that any expense is recoverable
It is not medical or legal advice
Records govern where this log and the records disagree
logInsurer communication log
Creates a dated record of every insurer contact, request, and offer, so nothing rests on recollection.
Open checklist
How to use it
- Add an entry during or immediately after every contact
- Follow significant calls with a short written summary by email
- Record what was requested and under what authority
- Keep copies of everything sent to you and everything you sign
The basics for every contact
- Date, time, and how contact was made
- Name, company, and whether it is your insurer or another party's
- Claim number referenced
- Who initiated the contact
What was asked
- Information or documents requested
- Whether a recorded statement was requested
- Whether an authorization was requested, and its scope
- What you were told was required, and on what basis
What was said and agreed
- What you provided or declined to provide
- Any offer made, and whether it was confirmed in writing
- Any deadline you were given
- What was promised, and by when
Documents exchanged
- Letters and emails received, with dates
- Anything you signed, with a copy retained
- Records or bills you sent, and when
- Anything you asked for in writing and did not receive
This is a private record and is not submitted to anyone
Keeping it does not satisfy any policy obligation you may owe your insurer
It does not preserve any filing deadline
It is not legal advice about what you must provide
worksheetInjury consultation worksheet
Turns a first meeting into an assessment by fixing the facts, the documents, and the questions in advance.
Open checklist
How to use it
- Complete the facts and documents sections before the meeting
- Bring your declarations page; coverage questions come up immediately
- Disclose the awkward facts rather than waiting to be asked
- Write the answers down, including who gave them
What happened
- Date, location, and a short factual sequence
- Who else was involved, and any report numbers
- Whether fault has been disputed or assigned to you
- Whether a government entity or business was involved
Injuries and treatment
- Injuries diagnosed, and by whom
- Whether treatment is ongoing or finished
- Any prior injury to the same body part
- Any gap in treatment, and the reason for it
Insurance and money
- Your own declarations page and coverages
- Any other policy that might apply
- Health insurance or program that has paid for treatment
- Losses documented so far, and what is still missing
What you have already done
These change the advice, and every one of them is better raised now than discovered later.
- Statements given, to whom, and whether recorded
- Authorizations or documents signed
- Offers received
- Any other firm you have spoken with or signed with
Questions to ask
- What deadline applies to a claim like mine, and where does it come from?
- Who handles my file, and would it be referred elsewhere?
- How often does this firm try cases?
- Are costs deducted before or after the fee is calculated?
- Do I owe advanced costs if there is no recovery?
- Who resolves liens and reimbursement claims, and is that inside the fee?
- What is the weakest part of my claim?
This does not evaluate your claim or establish its value
It is not submitted to anyone and collects no information about you
Completing it creates no attorney-client relationship
It does not preserve any filing deadline
Federal · U.S. General Services AdministrationSF-95 — Claim for Damage, Injury, or Death
Presents an administrative claim to a federal agency for property damage, personal injury, or death alleged to have been caused by a federal employee acting within the scope of employment.
Form guide
SF-95 — Claim for Damage, Injury, or Death
Presents an administrative claim to a federal agency for property damage, personal injury, or death alleged to have been caused by a federal employee acting within the scope of employment.
Someone whose claim is against the United States. It does not apply to claims against a state, county, city, school district, or other non-federal public body, each of which has its own separate scheme.
Before any lawsuit. Federal law requires a claim to be presented to the appropriate federal agency and denied in writing before an action may be instituted.
- The correct federal agency whose employee is alleged to be responsible
- Date, time, and place of the incident
- A description of what happened and the basis of the claim
- The nature and extent of injury or damage
- A sum certain — a specific dollar amount claimed
- Witness names and contact details, where there are any
What the sections ask for
Section explanations describe what a form is asking for in ordinary language. They are not instructions about what any individual should write, and they do not replace the official instructions published with the form.
Identifies which federal agency is being asked to consider the claim. Presenting to the wrong agency is a common and consequential error.
A description of the incident and why the claimant says a federal employee is responsible.
Asks for a specific figure. The requirement that a claim state a sum certain is why this box matters more than it appears to.
Signed by the claimant or an authorized representative, certifying the claim.
Common mistakes
- Presenting the claim to the wrong federal agency
- Using this form for a claim against a state, county, or city body
- Omitting the sum certain
- Filing suit before the agency has denied the claim in writing
- Assuming the standard form is the only acceptable format when the regulations permit other written notification
Last source check: 2026-08-20 · awaiting attorney review
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Lawyer in Town publishes general legal information for consumers. It is not legal advice, it does not create an attorney-client relationship, and it cannot account for the facts of any individual situation. Laws, court procedures, filing deadlines, and outcomes differ by state and by court, and they change over time. Confirm anything that affects a decision with a lawyer licensed in the relevant jurisdiction.
Medicare recovery obligations are federal, from CMS material. Rights held by employer plans, private insurers, providers, and state programs arise under federal law, state law, and plan terms, and differ substantially. No amount, rate, or reduction is stated.