6A-25.018. Recovery from Third Parties

(1) It shall be the policy of the division to seek reimbursement in full for all funds expended for vocational rehabilitation and related services from all parties liable therefor under Chapter 413, F.S. Third parties shall include first-party insurers and the Social Security Administration.

(2) The division shall seek the recovery of monies spent on behalf of an individual from a third party:

(a) Whenever a third party is liable for the payment of such services;

(b) From the individual if the individual has already received third-party payments;

(c) From the provider of the services if the provider recovers from the individual or a third party on behalf of the individual.

(3) When there is a possibility of a liable third party, the counselor, with the assistance of the individual, shall complete Form DVR-004, Subrogation Worksheet, as incorporated by reference in Rule 6A-25.019, F.A.C. The division shall request that the individual read and sign Form DVR-004, Subrogation Worksheet. Services to the individual provided through the division shall not be contingent upon the signing of this worksheet nor shall the subrogation rights of the division be contingent upon the individual signing the worksheet.

(4) The division may either file a lien meeting the requirements of Section 413.445, F.S., or notify the individual’s attorney by letter of the division’s right to subrogation. The failure of the division to file a lien or notify the individual's attorney in writing shall not affect the division’s subrogation rights.

(5) If the division receives a third party payment on either a pending Social Security Disability Benefits (SSDI) or Supplemental Security Income (SSI) claim or for which reimbursement has been received, then this shall be reported to the Social Security Administration.

(6) If the division has paid a vendor for services and the vendor is paid for those services by a third party, the vendor shall reimburse the division.

(7) If a vendor will not accept Medicaid or Medicare, the division may pay the vendor for services and recover from Medicaid.

(8) Under special circumstances, where undue financial hardship would result to the individual, the division may consider, in its sole discretion, whether to seek reimbursement or to seek reimbursement for less than all of such funds expended. Under such circumstances, the division shall consider the following factors in determining whether to seek less than full or no reimbursement:

(a) The amount of reimbursement being offered by any party liable therefor;

(b) Cost to the division of services rendered to the individual;

(c) Types of services rendered to the individual;

(d) Employment status of the individual;

(e) Cost to the individual of living independently;

(f) Additional liens against the individual resulting from medical or rehabilitation services provided to such individual;

(g) Whether any other lienors have reduced their liens;

(h) Whether any attorney representing the individual has reduced his/her fee;

(i) Other sources of income available to the individual; and,

(j) The cost effectiveness of pursuing the recovery.

(9) The division shall have the sole discretion, after consideration of such factors, to reduce or waive any claims the division may have under Section 413.445, F.S.

Rulemaking Authority 413.22, 413.445, 1001.02 FS. Law Implemented 413.445 FS. History–New 5-14-12, Formerly 38J-1.001.