State Codes and Statutes

State Codes and Statutes

Statutes > North-carolina > Chapter_135 > GS_135-45_15

§ 135‑45.15.  Liabilityof third person; right of subrogation; right of first recovery.

(a)        The Plan shall havethe right of subrogation upon all of the Plan member's right to recover from aliable third party for payment made under the Plan, for all medical expenses,including provider, hospital, surgical, or prescription drug expenses, to theextent those payments are related to an injury caused by a liable third party.The Plan member shall do nothing to prejudice these rights. The Plan has theright to first recovery on any amounts so recovered, whether by the Plan or thePlan member, and whether recovered by litigation, arbitration, mediation,settlement, or otherwise. Notwithstanding any other provision of law to thecontrary, the recovery limitation set forth in G.S. 28A‑18‑2 shallnot apply to the Plan's right of subrogation of Plan members.

(b)        If the Plan isprecluded from exercising its right of subrogation, it may exercise its rightsof recovery pursuant to G.S. 135‑40.13(g). If the Plan recovers damagesfrom a liable third party in excess of the claims paid, any excess will be paidto the member, less a proportionate share of the costs of collection.

(c)        In the event a Planmember recovers any amounts from a liable third party to which the Plan isentitled under this section, the Plan may recover the amounts directly from thePlan member. The Plan has a lien, for not more than the value of claims paidrelated to the liability of the third party, on any damages subsequentlyrecovered against the liable third party. If the Plan member fails to pursuethe remedy against a liable third party, the Plan is subrogated to the rightsof the Plan member and is entitled to enforce liability in the Plan's own nameor in the name of the Plan member for the amount paid by the Plan.

(d)        In no event shallthe Plan's lien exceed fifty percent (50%) of the total damages recovered bythe Plan member, exclusive of the Plan member's reasonable costs of collectionas determined by the Plan in the Plan's sole discretion. The decision by thePlan as to the reasonable cost of collection is conclusive and is not a"final agency decision" for purposes of a contested case underChapter 150B of the General Statutes. Notice of the Plan's lien or right torecovery shall be presumed when a Plan member is represented by an attorney,and the attorney shall disburse proceeds pursuant to this section.  (2004‑124, s. 31.25;2006‑264, s. 66(a); 2008‑168, ss. 1(a), 3(a), (t).)