This morning on CNN they aired a story based on a story from The Wall Street Journal, in which a disabled woman must pay back Wal-Mart for her medical expenses. Seems that about 7 years ago, Deborah Shank was hit broadside by a semi truck and suffered massive brain damage. Deborah has been employed by Wal-Mart when she had the accident and also had a medical policy with the company. Hidden in the small type was a clause that if you receive a court settlement for the injury, you must pay back Wal-Mart.
The Shank family did received $417,000 settlement and Wal-Mart now wants some $470,000 paid back. In the WSJ article it states:
“I don’t understand why they need to do this,” says Mr. Shank on a recent visit to the nursing home, between shifts as a maintenance worker and running a tanning salon. “This girl needs the money more than they do.” Mrs. Shank, who needs help with eating and other basic tasks, spends more time alone since Mr. Shank had to let her private caregiver go. At some point, he says, she may have to be moved from a private to a semi-private room in the nursing home where she lives.
The reason is a clause in Wal-Mart’s health plan that Mrs. Shank didn’t notice when she started stocking shelves at a nearby store eight years ago. Like most company health plans, Wal-Mart’s reserves the right to recoup the medical expenses it paid for someone’s treatment if the person also collects damages in an injury suit.
Until recently, many employers didn’t vigilantly enforce the provision, and some states and federal courts didn’t think the claim held water. But as the cost of covering workers continues to escalate, employers and health plans are getting more aggressive about going after the money. A Supreme Court ruling last year also has given them a clearer legal map to suing employees and winning.
In insurance circles, the recovery practice is called “subrogation.” Employers and insurers say it’s necessary to ensure that medical expenses aren’t paid twice. By recovering those costs from someone who’s been compensated elsewhere, they argue, they’re saving money for everyone on the plan.
I don’t doubt Wal-Marts claim as being legitimate. Even if it was concealed in the small print they do have a right to file a claim for the money owed to the insurance plan. But what rubs me the wrong way is the situation. There should be some type of an exception to the rule in cases when a person is totally disabled. This family needs the small amount they won in court to pay for the woman’s medical care in a nursing home.
What do you think? Comments welcome.
PS Wal-Mart took in $90 billion dollars last year.
PSS I also forgot to mention that because of this woman’s brain damage, she can not comprehend that her son was killed in Iraq while serving our country.
Full WSJ article is here.
[tags]wal-mart, sued, medical coverage, pay back, [/tags]