Texas Made-Whole Rule Takes a Hit
November 13, 2007 | Attorneys' Fees, ERISA, Made Whole Rule, Plan Language, Provider Reimbursement, Summary Plan Description, Texas | 1 CommentThe Texas Made-Whole Rule, adopted in Ortiz v. Great Southern Fire & Casualty Insurance Co., no longer applies to cases where the Plan disclaims the rule and requires full reimbursement in the plan document. 597 S.W.2d 342, (Tex. 1980). In the Ortiz case the insurance carrier relied upon arguments made in equity. The court held that health plans do not have an equitable right to recovery until the plan beneficiary is fully compensated. Id. Read more