North Dakota Health Plan Reimbursement: Made-Whole and Common Fund

By the FigureMyTax Editorial Team · How we calculate

We did not find a North Dakota statute that governs a health plan's reimbursement from your settlement. A compendium of subrogation law reports that North Dakota allows subrogation of medical and disability benefits and applies neither the made-whole nor the common fund doctrine.

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. Some states enact it by statute; others leave it to courts. We found no North Dakota statute for a health plan.

What a compendium reports

A law-firm compilation of North Dakota subrogation law reports that subrogation of medical and disability benefits is allowed, that the made-whole and common fund doctrines do not apply, citing a 2013 decision on a hospital lien, and that North Dakota has not adopted made-whole for health plans. We did not read the decision, so treat this as a lead.

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 compendium is right and the plan has a valid reimbursement clause, it can claim the full $9,000 with no reduction for your fees or for any shortfall in your recovery. The North Dakota medical lien calculator shows that and a no-claim position.

Hospital liens and Medicaid are different

Hospitals have a statutory lien (N.D.C.C. 35-18-01) that also reaches insurance payable to you, and Medicaid has its own statute (50-24.1-02.1). See how hospital liens work and the Medicare and Medicaid post.

What to do

Ask for an itemized claim and the plan document, check for a valid reimbursement clause, ask whether the plan is insured or self-funded, and ask it to reduce its claim. 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 North Dakota's rules apply to your specific case with a licensed North Dakota attorney.