Nevada Health Plan Reimbursement: Made-Whole and Common Fund

By the FigureMyTax Editorial Team · How we calculate

We did not find a Nevada statute that governs a health plan's reimbursement from your settlement. A compendium of subrogation law reports that Nevada applies the made-whole rule but a policy can override it in clear language, and that the common fund rule applies.

What the made-whole rule is

The made-whole doctrine says an insurer that paid your bills cannot be repaid from your recovery until you have been fully compensated for your losses. Some states enact it by statute; others leave it to courts. We found no Nevada statute for a health plan.

What a compendium reports

A law-firm compilation of Nevada subrogation law reports that subrogation of medical benefits is allowed, that the made-whole doctrine applies but can be overridden by clear policy language, citing Canfora v. Coast Hotels (2005) and a 2011 decision, and that the common fund doctrine applies. We did not read the decisions, so treat these as leads.

A worked example

Say a health plan paid $9,000 and you settle for $100,000 with a one-third fee and $3,000 in costs. If the policy does not clearly override made-whole and your damages are $300,000, the plan may recover nothing. If it clearly overrides it, the common fund rule would have it bear about 36.3 percent of its claim for fees and costs and recover about $5,730. The Nevada medical lien calculator offers those positions.

Medicaid and hospital liens are different

Medicaid has its own subrogation statute (NRS 422.293) and hospitals have a statutory lien (108.590); neither depends on whether you are made whole. See the Medicare and Medicaid post and how hospital liens work.

What to do

Ask for an itemized claim and the plan document, look for clear language about made-whole, ask whether the plan is insured or self-funded, and ask it to reduce its claim for your fees and costs. A self-funded employer plan is governed by federal law.

This is general information, not legal advice, and the state comparisons above are illustrative, not an exhaustive survey. Confirm how Nevada's rules apply to your specific case with a licensed Nevada attorney.