SUBROGATION CLAIM RESOLUTION WORKSHEET

Case Name: [________________________________]
Case/Claim Number: [________________________________]
Date of Incident: [__/__/____]
Date Prepared: [__/__/____]
Prepared By: [________________________________]

SECTION 1: CASE OVERVIEW

Settlement/Verdict Information:

Breakdown of Damages:

SECTION 2: SUBROGATION CLAIM IDENTIFICATION

List All Subrogation/Reimbursement Claims:

Lien Type Key:

• ERISA = Self-Funded ERISA Health Plan
• INS = Insured Health Plan
• MCARE = Medicare
• MCAID = Medicaid
• WC = Workers' Compensation
• AUTO = Auto Insurance (PIP/MedPay)
• OTHER = Other Subrogation Interest

SECTION 3: INDIVIDUAL SUBROGATION CLAIM ANALYSIS

Claim 1: [________________________________]

Contact Information:
| Field | Information |
|-------|-------------|
| Subrogation Company/Department | [________________________________] |
| Contact Name | [________________________________] |
| Phone | [________________________________] |
| Email | [________________________________] |
| Address | [________________________________] |
| Reference/Claim Number | [________________________________] |

Claim Details:

Legal Basis:
☐ Contractual (Plan Language)
☐ Statutory
☐ Equitable
☐ ERISA Preemption Applies

Applicable Reduction Doctrines:

Negotiation Target: $ [________________]

Claim 2: [________________________________]

Contact Information:
| Field | Information |
|-------|-------------|
| Subrogation Company/Department | [________________________________] |
| Contact Name | [________________________________] |
| Phone | [________________________________] |
| Email | [________________________________] |
| Reference/Claim Number | [________________________________] |

Claim Details:

Applicable Reduction Doctrines:

Negotiation Target: $ [________________]

Claim 3: [________________________________]

Contact Information:
| Field | Information |
|-------|-------------|
| Subrogation Company/Department | [________________________________] |
| Contact Name | [________________________________] |
| Phone | [________________________________] |
| Email | [________________________________] |
| Reference/Claim Number | [________________________________] |

Claim Details:

Negotiation Target: $ [________________]

SECTION 4: REDUCTION DOCTRINE ANALYSIS

A. Made Whole Doctrine

Definition: The principle that an insured must be fully compensated for their injuries before a subrogee can recover.

Applicability Analysis:

Argument for Made Whole Reduction:
[________________________________]
[________________________________]

B. Common Fund Doctrine

Definition: A lienholder benefiting from an attorney's recovery efforts should contribute proportionally to attorney fees and costs.

Plan Language on Attorney Fees:
☐ Silent (Common Fund May Apply)
☐ Expressly Excludes Fee Sharing
☐ Permits Fee Sharing
☐ ERISA Plan - Check McCutchen Analysis

C. Comparative Fault Reduction

D. Pro Rata/Insufficiency Reduction

When settlement is less than full damages, liens may be reduced proportionally.

SECTION 5: NEGOTIATION WORKSHEET

Pre-Negotiation Preparation:

☐ Obtained complete payment records from lienholder
☐ Reviewed plan/policy language
☐ Identified applicable state law
☐ Determined ERISA status (if health plan)
☐ Calculated reduction arguments
☐ Prepared settlement breakdown
☐ Documented limitations on recovery

Negotiation Arguments Checklist:

☐ Made Whole - Client not fully compensated
☐ Common Fund - Attorney fees should be shared
☐ Comparative Fault - Recovery reduced by client's fault
☐ Pro Rata - Settlement less than full damages
☐ Disputed Charges - Payments not related to accident
☐ Policy Limits - Recovery limited by insurance
☐ Hardship - Client's financial circumstances
☐ Future Medical Needs - Ongoing care required
☐ Other: [________________________________]

Negotiation Tracking:

Negotiation Notes:

SECTION 6: RESOLUTION SUMMARY

Final Lien Amounts:

Settlement Distribution:

SECTION 7: LIEN RELEASE DOCUMENTATION

Release Status:

Required Documentation:

☐ Written lien reduction/waiver agreements
☐ Payment receipts/cleared checks
☐ Lien satisfaction letters
☐ Medicare final demand letter (if applicable)
☐ Medicaid release (if applicable)
☐ ERISA plan acknowledgment
☐ Workers' comp release (if applicable)

SECTION 8: SPECIAL CONSIDERATIONS

Medicare Considerations:

☐ Medicare conditional payments identified
☐ MSPRC demand letter received
☐ Disputed items identified
☐ Waiver/compromise requested
☐ Final demand received
☐ Payment made
☐ Medicare Set-Aside required? ☐ Yes ☐ No

ERISA Plan Considerations:

☐ Plan document obtained
☐ Self-funded status confirmed
☐ Subrogation/reimbursement language reviewed
☐ Made whole language analyzed
☐ Attorney fee language analyzed
☐ US Airways v. McCutchen considered

Workers' Compensation Considerations:

☐ WC lien amount verified
☐ Future credit calculated
☐ Employer contribution to fault evaluated
☐ Witt v. Jackson analysis (if applicable)
☐ State-specific offset rules applied

SECTION 9: DOCUMENTATION CHECKLIST

☐ Complete payment records from all lienholders
☐ Plan/policy documents
☐ Subrogation/reimbursement claim letters
☐ EOBs for all medical payments
☐ Settlement agreement/release
☐ Correspondence with lienholders
☐ Negotiation notes and offers
☐ Final lien reduction agreements
☐ Payment receipts
☐ Lien satisfaction/release letters
☐ Client authorization for lien negotiation
☐ Disbursement statement

SECTION 10: NOTES

[________________________________]
[________________________________]
[________________________________]
[________________________________]
[________________________________]

CERTIFICATION

I certify that this subrogation resolution worksheet accurately reflects the subrogation claims, negotiations, and resolutions in this matter. All lien amounts have been verified and all reductions have been documented.

Signature: ________________________________________ Date: [__/__/____]

Print Name: [________________________________]

Title: [________________________________]

SOURCES AND REFERENCES

• Seitelman Law: Understanding Subrogation Liens in Personal Injury Cases
• FindLaw: Tips for Negotiating ERISA Liens
• Baxley Maniscalco: Understanding Subrogation and Liens
• US Airways v. McCutchen, 569 U.S. 88 (2013)
• Synergy Settlement Services: ERISA Lien Resolution

This worksheet is for informational purposes only. Subrogation rights and negotiation strategies vary significantly by payor type and jurisdiction. Consult legal counsel regarding applicable law and case-specific strategy.