cmonfils | January 18, 2012
Employer’s Guide to Self-Insuring Health Benefits January 2012 | Vol. 19, No. 4
In a surprising decision, the 3rd U.S. Circuit Court of Appeals used the concept of “appropriate equitable relief” to restrict an employer-sponsored health plan’s recovery from a third-party settlement. Full reimbursement of what the plan paid out would have been “inappropriate and inequitable,” even though the plan had asserted recovery rights over any monies collected from a third party. Full recovery would have been unfair because: (1) the plan participant’s recovery ended up being less than what the plan paid after attorney’s fees were deducted; and (2) the plan never intervened in the third-party recovery. The outcome diverges from many recent cases, which upheld plans’ claims on total proceeds, regardless of whether the plan participant was “made whole” or had money to pay attorney’s fees. (more…)
Category: 3rd, Common Fund, ERISA, Pennsylvania, Reimbursement, Subrogation, Third Party Agreements |
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cmonfils | July 11, 2011
Matthiesen, Wickert & Lehrer, S.C. June 2011 Newsletter
By Ryan L. Woody
The Northern District of California recently came out with a surprisingly subrogation-friendly decision regarding application of the Made Whole and Common Fund Doctrines. In Aetna Life Ins. Co. v. Kohler, 4:11-CV-004390CW (N.D. Cal., May 23, 2011) an ERISA-sponsored Plan sought reimbursement from a husband and wife who settled their personal injury lawsuit. (more…)
Category: California, Common Fund, Made Whole Rule |
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cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
It is well established that a health plan subject to ERISA can recover the benefits it paid from identifiable tort settlement proceeds held by the plan participant’s attorney. When those proceeds are identifiable as to their source an equitable lien can be asserted against the proceeds. If a self-funded ERISA health plan is subject to the common fund rule, both the attorney and the plan would have to share client’s attorney’s fees, and each of them would bear a pro rata share of the tort settlement proceeds (that is, the common fund). (more…)
Category: 9th, California, Common Fund |
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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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cmonfils | April 12, 2011
www.subrogation.org
Texas recently introduced a bill allowing recovery of attorney’s fees by a prevailing party when a trier of fact determines there has been an “abusive civil action”. An attorney may be held jointly and severally liable for litigation costs awarded, if they have a financial interest in the action. Financial Interest is defined as an attorney’s compensation for services being contingent in whole or in part on the outcome of the action. This bill would only apply when the amount in controversy is or exceeds $100,000.00. Worker’s compensation claims are excluded from the bill.
Thanks to William T. Sebesta, an attorney with Doyen Sebesta in Houston, Texas, for identifying this bill.
Category: Attorneys' Fees, Common Fund, Subrogation, Texas |
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cmonfils | February 2, 2011
www.healthplanlaw.com
January 20, 2011 •
Johnson Controls v. Flaherty, 2011 U.S. App. LEXIS 969 (11th Cir.) (January 18, 2011) (unpublished) presents a typical subrogation scenario. The plan brought suit under 29 U.S.C. § 1132(a)(3), for medical benefits that the employee benefits plan, Johnson Controls, Inc. Welfare Plan (”the Plan”), had paid resulting from a bicycle injury. The Defendant had successfully settled a personal injury case and recovered proceeds for the injury from a third party. (more…)
Category: Attorneys' Fees, Common Fund, ERISA, Subrogation |
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cmonfils | December 29, 2010
www.laborandemploymentlaw.ncbar.org
Article Date: Friday, December 17, 2010
Written By: Robert Ward Shaw & Mark Stanton Thomas
The U.S. District Court for the Eastern District of North Carolina recently held that the Employee Retirement Income Security Act of 1974 (“ERISA”) precludes a plan administrator with a claim against the insured for amounts recovered from a third party for medical benefits from pursuing equitable remedies against the insured attorney’s contingency fee award. (more…)
Category: 4th, Common Fund, Subrogation |
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