By Matt Smith
You may or may not be familiar with the term subrogation. Simply put, subrogation is the right for an insurer to pursue a third party that caused a loss to the insured. For example, think of an insured person who is in an auto accident caused by another person. That other person, or their insurance company, should ultimately pay the claim, not the insured or their insurance company.
Don’t let me lose you with that opening – there are lots of dollars at stake here.
A subset to traditional subrogation cases, which can be characterized as losses or injuries resulting from auto accidents, slip and falls and the like, are “mass tort” cases. These are civil actions that have many plaintiffs involved against one or several defendant corporations. These situations include illness or injury from dangerous pharmaceuticals, defective medical devices or harmful toxic substances that involve hundreds, thousands or — at times — millions, of people.
Mass tort cases can be very complex. The challenge facing healthcare payers today is that mass tort cases are not like typical subrogation injury cases, and it is extremely difficult to identify injured members and related medical claims. There can be thousands of injured people and multiple insurance companies involved in one mass tort case. Most payers settle their claims for pennies on the dollar to avoid the difficult task of identification and recovery, or do not get involved at all and miss out on significant recovery of paid claims dollars.
Conduent has been a leader in the traditional subrogation identification and recovery industry for over 30 years, but has not ventured into the mass tort subrogation market until now. Conduent is partnering with Healthcare Recovery Solutions (HRS), whose team of experts specialize in uncovering mass tort related injury claims. HRS’ legal and technical expertise, combined with Conduent's skills in recovery and negotiation, will allow Conduent to enter the mass tort market and make a significant recovery impact for our customers.
HRS will provide to Conduent and its customers a powerful tool that will unlock the real potential of mass tort claims. Their patented software system seeks out third-party claims related to unsafe medications or faulty medical devices, for example, which until now have been extremely hard to identify. This technology, and HRS’ team of experienced counsel, will provide an alternative to traditional pursuits. It allows our customers to avoid the crowded field of plaintiffs fighting for a small piece of a settlement and provide them a solution to make a claim independently.
How it works
When a mass tort litigation has concluded, and if the manufacturer is found liable and agrees to pay the plaintiffs, HRS will identify the cross-section of people who were involved in the case. Conduent will then work with the manufacturer to reimburse the individuals’ healthcare insurance company those funds that were disbursed on their behalf. HRS’ patented software identifies people involved in mass litigation who are not being identified today, and represent a significant opportunity to offset claims that have already been paid. Conduent and HRS work hand-in-hand throughout the process to ensure an efficient and member-friendly course is in place. Comprehensive monitoring and reporting will also be provided for the claims being pursued to guarantee the insurer is reimbursed.
Why it matters
Over $3 trillion dollars in healthcare are spent annually in the United States, according to the National Health Expenditure Accounts. With nearly 90 percent of Americans insured, insurance payment integrity and recovery is a growing, multi-billion dollar market. This partnership allows us to expand the subrogation services we offer to our health insurance clients today. It also significantly increases the value we bring to our clients by offering a service that will help identify missing opportunities not previously identified or pursued.
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