42 C.F.R. § 411.53
Basis for conditional Medicare payment in no-fault cases
(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances:
(1) The beneficiary has filed a proper claim for no-fault insurance benefits but the intermediary or carrier determines that the no-fault insurer will not pay promptly for any reason other than the circumstances described in § 411.32(a)(1). This includes cases in which the no-fault insurance carrier has denied the claim.
(2) The beneficiary, because of physical or mental incapacity, failed to meet a claim-filing requirement stipulated in the policy.
(b) Any conditional payment that CMS makes is conditioned on reimbursement to CMS in accordance with subpart B of this part.
Notes of Decisions
Cited in 2
cases (2 in the last 5 years), 2021–2026 · leading case: Lynette Duncan v. Liberty Mut. Ins. Co., 854 F. App'x 652 (6th Cir. 2021).
Lynette Duncan v. Liberty Mut. Ins. Co., 854 F. App'x 652 (6th Cir. 2021). “42 C.F.R. § 411.53 . Further, 42 C.F.R. § 411.”
MSP Recovery Claims v. Merchants Mut. Ins. Co., No. 1:19-cv-00524 (W.D.N.Y. Jan. 8, 2026). “” Similarly, 42 C.F.R. §411.53 , entitled “Basis for conditional Medicare payment in no-fault cases”, provides: “(a) A conditional Medicare payment may be made in no-fault cases under either of the following circumstances: (1) The beneficiary has filed a proper claim for…”
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