Liability Development

10.8.3 - Liability Development (Rev. 39, Issued: 10-21-05; Effective Date: 10-01-05; Implementation Date: 11-19-05) The COBC develops to determine if a liability (including automobile liability) insurance claim has been or will be filed. If, as a result of that development or receipt of self-reported information (for example, letter from beneficiary or attorney or other beneficiary representative, notification from provider), the beneficiary/representative indicates the intent to file a liability insurance claim, the beneficiary/representative is notified by the COBC of Medicare's potential recovery claim, if there is a settlement, judgment, or award, the COBC shall, where appropriate, send the attorney or other beneficiary representative a release agreement to be completed and returned directly to the lead contractor. The lead contractor shall post a termination date if it is notified that a liability case has been resolved through a settlement, judgment or award and does not provide for future medical payments. If its recovery development efforts find additional information that serves to modify the information that is contained on CWF, it sends a CWF Assistance Request to the COBC via ECRS (See §10.2.1). If the COBC's development indicates there is a possible payment under liability insurance, the contractor shall make conditional payment. The COBC shall designate a lead contractor to monitor the progress of the liability claim and coordinate Medicare recovery efforts (See Chapter 7, §50.5). See §10.8.1 for instructions where a liability insurance claim follows a no-fault situation; the lead contractor is responsible for the same type of actions where a no-fault claim follows a liability claim.