cmonfils | August 25, 2011
Braintree, Massachusetts 08/23/11 – A class action lawsuit was recently filed in the State of New York (Rebecca Meek-Horton v. Trover Solutions, Inc. et.al, State of New York, Supreme Court, New York County, Case No. 108804-2011), which alleges that Medicare Advantage Plans violate a New York State law when they impose liens on participants who receive personal injury settlements, arising from injuries for which said Advantage Plan has already advanced payment. (more…)
Category: Collateral Source Rule, Medicare, New York, Reimbursement |
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cmonfils | July 11, 2011
The Subrogator Spring/Summer 2011
Amidst the deluge of healthcare reform, anti-subrogation legislation was passed in the State of New York on November 12, 2009, which purported to eliminate the right of fully insured carriers and self-funded benefit plans, coming within the purview of state law, to pursue subrogation and reimbursement. Accordingly, benefit plans in New York which are not private, self-funded plans, no longer have an enforceable right to subrogation and/or reimbursement. The Phia Group has never accepted anti-subrogation legislation without a fight. When the Phia Group received word of the statutory shift, its attorneys immediately began to seek out ways to enforce plan rights. (more…)
Category: Collateral Source Rule, New York, Subrogation |
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cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
New York Trial Court Lets Health Plan Intervene in Malpractice Action
Until recently, all the cases we see involving subrogation and reimbursement involve situations where someone who incurred serious medical expenses and received a favorable tort settlement ends up in competition with his or her own health plan exercising reimbursement rights on the settlement or judgment proceeds.
We are now beginning to see cases where the plan participant has died from the injuries leading to the tort settlement or judgment, and the deceased plan participant’s family seeks to recover damages for their own loss arising from the plan participant’s death, usually based on state statutes providing for a cause of action by those family members in those circumstances. (more…)
Category: Collateral Source Rule, New York |
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cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
Three major rules limit group health plans’ right to seek reimbursement of health benefits they paid from tort settlement proceeds. They are: (1) the make-whole rule, which precludes the plan’s right to reimbursement if the plan participant is not “made whole” by the tort settlement; (2) the common fund rule, which requires the plan to bear a pro rata share of attorney’s fees and court costs while partaking of the “common fund” created by the settlement; and (3) the collateral source rule, which allocates the tortfeasor’s liability for damages to either the plan participant or the plan, but not to both of them. Contributing Editor Jack Helitzer reports on cases dealing with each of these rules. Ill-conceived plan documents in one case and a court that failed to observe Supreme Court precedent in another hurt plans. Only one of the three (enabling a plan to intervene and introduce health care data in a tort case) had a favorable result for the plan. (more…)
Category: Collateral Source Rule, Common Fund, Made Whole Rule, Subrogation |
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