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Subrogation Rights Assignment of Reimbursement

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Subrogation Rights: Assignment of Reimbursement

Current Effective Date:


Revision History:

Revised 04/03

Subrogation rights legally allow the Division of Services for the Blind (DSB) to recoup funds spent in the Vocational Rehabilitation (VR) of eligible individuals who may eventually be compensated for their injury (ies) by another third party. ASSIGNMENT OF REIMBURSEMENT form (On-Line DSB-0613-VR Assignment of Reimbursement with instructions) must be completed and dispensed prior to the provision of any Vocational Rehabilitation Services which are subject to financial eligibility and if there is a likelihood of future litigated or negotiated compensation from another source. Financial Responsibility/Economic Need Requirements (On-Line DSB-4040-VR Economic Need Survey with instructions). Once Assignment of Reimbursement is appropriately completed and dispensed, the State Agency may sponsor VR services. At such time a settlement is reached, the Agency must reclaim its expenditure. The Assignment of Reimbursement must be completed under the following circumstances:

The individual applying for services must sign the Assignment of Reimbursement after it is fully completed. If the individual is under eighteen, then the parent, guardian, or other legally recognized individual representative must also sign the Assignment of Reimbursement. Failure to sign constitutes failure to cooperate in the Agency's legal responsibility to use comparable benefits and financial eligibility requirements, thus negating Eligibility to receive services based on these contingencies. The Assignment of Reimbursement must be notarized. Failure on the Vocational Rehabilitation Counselor's part to fully complete and accurately dispense the Assignment of Reimbursement will impede, if not negate, the Agency's ability to recoup these funds. Mail completed Assignment of Reimbursement forms by certified mail to the insurance carrier, employer, and attorney.

Vocational Rehabilitation Counselors should contact the Chief of Rehabilitation Field Services in the State Office who will direct the managerial dissemination of this information to the Responsible party as settlement is in progress. All negotiations for partial settlements with the Agency must be handled in this manner. The following are two conditions under which the Agency will entertain requests:

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