TennCare has a statutory subrogation interest provided by Tenn. Code Ann. sec. 71-5-117. Under the statute, once a personal injury plaintiff’s attorney is on notice that TennCare has an interest, the attorney has an obligation to contact TennCare or the plaintiff’s managed care organization “before the entry of a judgment or settlement” to find out the amount of TennCare’s asserted subrogation interest. Tenn. Code Ann. sec. 71-5-117(g). TennCare’s subrogation interest is often small in comparison to the tort victim’s damages, if for no other than reason than the amount that health care providers write off from the patient’s medical expenses when accepting payment from TennCare. When a plaintiff’s damages bump into the available insurance policy limits, however, TennCare’s subrogation interest can be a significant barrier to accepting a reasonable settlement. Fortunately, Tenn. Code Ann. sec. 71-5-117 provides a remedy if TennCare or its MCO will not accept a reasonable reduction – a hearing by the trial judge to adjudicate TennCare’s subrogation amount.
In essence, Tenn. Code Ann. sec. 71-5-117 codifies both the “made whole” rule and the “common fund” rule, reducing TennCare’s recovery by the same factors that the plaintiff faces in evaluating a settlement.
First, the trial judge determines TennCare’s gross subrogation interest. The court looks to the medical expenses that the plaintiff could expect to prove at trial. The court also hears evidence introduced about TennCare’s total payments for those medical expenses. Tenn. Code Ann. sec. 71-5-117(g).