Opinion ID: 2218842
Heading Depth: 1
Heading Rank: 5

Heading: Perry's Application to DSS.

Text: On June 30, as expressed in the parties' stipulation, [s]ince Perry is quadriplegic, he signed `X' on the application for assistance and assignment form of the Nebraska Department of Social Services (DSS) which contained: I understand that as a condition of receiving medical assistance all rights to third party payments for medical care and services paid on behalf of myself and any other members of the assistance unit for whom I can legally make an assignment are assigned to the Nebraska Department of Social Services as required by State Law. I understand that third party payments include any payment owed under a court or administrative agency and payment under an insurance policy. Medicare benefits are not assigned. Although a signature line was supplied near and below the foregoing and other printed material on page 17 of the DSS application, no signature appeared on page 17 at the place provided. However, opposite the printed direction SIGN HERE on page 18, Perry, as acknowledged by the stipulation, made his X in the space provided for the Signature of Applicant. Neb.Rev.Stat. § 68-1026 (Reissue 1986) provided in pertinent part: The application for medical assistance benefits ... constitutes an automatic assignment of the rights specified in this section to the Department of Social Services effective from the date of eligibility for such benefits.... Pursuant to this section, the applicant or recipient assigns to the department any rights to medical care support available to him or her ... and any rights to pursue or receive payments from any third party liable to pay for the cost of medical care and services arising out of injury, disease, or disability of the applicant or recipient.... Benefits assigned to the department by operation of this section may be directly reimbursable to the department by liable third parties ... when prior notification of the assignment has been made to the liable third party.