Adam V. Russo | May 27, 2008
In two separate cases, courts have found that health plans may refuse to pay benefits if participants or their attorneys refuse to sign reimbursement agreements. Some attorneys refuse to sign such agreements because they believe the plan is not entitled to fulfill reimbursement under applicable law. However, in many cases, the plan then refuses to pay any further benefits. The two cases are Cossey v. Associates Health and Welfare Plan, 2008 WL 276282 (E.D. Ark., Jan. 30, 2008) and Metal Technologies v. Ramirez, 2008 WL 153534 (E.D Wis., Jan 11, 2008). (more…)
Category: 8th, Signed Subrogation Agreements |
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Adam V. Russo | May 27, 2008
With the U.S. Supreme Court decision in Sereboff v. Mid Atlantic Medical Services, Inc., it became clear that ERISA plans can enforce their subrogation and/or reimbursement provisions by asserting a claim for a constructive trust or equitable lien against clearly identifiable tort settlement or judgment proceeds. In most instances, those proceeds end up either in the plan participant’s attorney’s escrow or trust accounts or are held by a court if the third party’s casualty insurer deposits the funds there. (more…)
Category: 11th |
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Adam V. Russo | May 27, 2008
ERISA did not preempt a Louisiana Department of Insurance directive that limits insurer’s subrogation and reimbursement rights to cases where covered individuals have been “made whole”, the 5th U.S. Circuit court of Appeals ruled in Benefit Recovery Inc. v. Donelon, 2008 WL 642972 (5th Cir. March 11,2008). (more…)
Category: 5th, Made Whole Rule, Preemption |
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Adam V. Russo | May 19, 2008
By Ron E. Peck, Esq.
If you have read the postings below (addressing the ongoing Supreme Court case of MetLife v. Glenn) you will note that the matter of what standard of review a Court applies when reviewing an administrator’s decision, is a major topic of conversation. The issue literally dominates how much power administrators will have to interpret the terms of their plan documents. In general, having discretion to interpret terms, and enjoying the Court deference that comes with it, is extremely important to administrators. Discretion and deference, however, do not always guarantee Court acceptance of an administrator’s interpretation of plan terms. (more…)
Category: 4th, Summary Plan Description |
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Adam V. Russo | May 12, 2008
By Ron E. Peck, Esq.
On April 30th, we posted a discussion of the ongoing Supreme Court case, MetLife (Metropolitan Life Insurance Company), et al. v. Wanda Glenn, 128 S.Ct. 1117. To review, in that case the Court is questioning whether a deferential standard of review – the standard ordinarily applied by Courts reviewing ERISA administrator decisions when the Plan reserves discretionary authority – should be replaced by a more searching analysis when the administrator financially benefits from denials. (more…)
Category: 6th, Summary Plan Description, Supreme Court |
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Adam V. Russo | May 6, 2008
Although Lumbermens Mutual Casualty Company’s Summary Plan Description (“SPD”) clearly states that its Plan Administrator, Kemper Ins., has the discretionary authority to determine eligibility for disability benefits and to interpret the terms of the plan, both the District Court and Ninth Circuit Court of Appeals applied a de novo standard of review, instead of a deferential standard of review in this case, since Lumbermens violated ERISA regulations by failing to properly distribute the SPD to its plan participant, Linda Gertjejansen, (Gertjejansen v. Kemper Ins. Companies, Inc., Slip Copy, 2008 WL 1787484 (C.A.9 (Cal.)). (more…)
Category: 9th |
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