party payer — Payments — Recovery worksheet. A. Recovery against the party that received payment. 1. General rule. Any payor of money benefits with recovery or reimbursement rights by contract or statute reduces its recovery to take account of the cost of procuring the judgment or settlement from a third party, as provided in this section, if: a. procurement costs are incurred because the claim is disputed, and b. those costs are borne by the party against which the payor seeks to recover. 2. Special rule. If a payor must file suit because the party that received payment opposes the payor's recovery, the recovery amount is as set forth in subsection E of this section. B. Recovery against the third-party payer. If the payor seeks recovery from the third-party payer, the recovery amount will be no greater than the amount determined under subsection C, D or E of this section. C. Payments made by a payor that are less than the judgment or settlement amount. If a payor's payments are less than the judgment or settlement amount, the recovery is computed as follows: 1. Determine the ratio of the procurement costs to the total judgment or settlement payment; 2. Apply the ratio to the person or entity's payment. The product is the payor's share of procurement costs; and 3. Subtract the payor's share of procurement costs from his or her claimed payments. The remainder is the payor's recovery amount. D. A payor's payments that equals or exceeds the judgment or settlement amount. If payor's payments equal or exceed the judgment or settlement amount, the recovery amount is the total judgment or settlement payment minus the total procurement costs. E. The payor incurs procurement costs because of opposition to its recovery. If the payor must bring suit against the party that received payment because that party opposes the recovery, the recovery amount is the lower of the following: 1. The person or entity's payment; or 2. The total judgment or settlement amount, minus the party's total procurement cost. F. Recovery worksheet. The amount to be recovered from the beneficiary is the amount payor paid, less a proportionate share of the costs of procuring the judgment or settlement. The amount to be refunded is determined as follows: If the payor's payment is less than the amount of judgment or settlement: 1. Determine the ratio of the payments to the total amount of the judgment or settlement; 2. Apply this ratio to the costs of procuring the judgment or settlement, including attorney fees; and 3. Subtract the payor's share of procurement costs from their payments. The remainder is the amount of reimbursement to be refunded to the payor seeking recovery of payments. Step 1: $_________________ / $_________________ = __________________ Payor's Payment Judgment/Settlement Ratio Carry out 6 digits Step 2: __________________ X $_________________ = __________________ Ratio from Step 1 Procurement Costs Payor's Share of Carry out 6 digits Procurement Cost Step 3: $_________________ - $_________________ = __________________ Payor's Payment Payor's Share of Refund to Payor Procurement Costs G. If the payor's payments equal or exceed the amount of the judgment or settlement, subtract the total procurement costs from the judgment or settlement. The remainder is the amount of reimbursement to be refunded to the payor. The beneficiary will not be required to refund more than the liability insurance payment minus the procurement costs. $_________________ - $_________________ = $_________________ Judgment/Settlement Procurement Costs Refund
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