cmonfils | August 30, 2011
www.myhealthguide.com
MyHealthGuide Source: David Slaughter, Thompson Publishing, 8/26/2011, http://smarthr.blogs.thompson.com/
Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, says, “David Slaughter’s Blog reports an interesting and unprecedented use of ERISA (not HIPAA) by Liberty Mutual to resist Vermont’s health claims data-reporting mandate. The state agency’s top attorney tells David in an exclusive interview that it is backing down from its initial demand for claims data about the company’s ERISA plan participants.” (more…)
Category: ERISA, Vermont |
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cmonfils | August 30, 2011
www.myhealthguide.com
MyHealthGuide Source: Mary V. Bauman, Miller Johnson Attorneys and Counselors, 8/25/2011, Miller Johnson Article
Article recommend by John H. Eggertsen, Esq., Eggertsen Consulting, P.C., www.jhelaw.com
Currently, Michigan imposes a 6% use tax on Medicaid HMOs and plans providing Medicaid mental health services. The purpose of the use tax is to finance the state’s share of Medicaid. The federal government has indicated it will bar Michigan from continuing this financing approach. As a result, Michigan needed to repeal the use tax and come up with a replacement revenue stream. (more…)
Category: ERISA, Michigan |
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cmonfils | August 30, 2011
www.myhealthguide.com
MyHealthGuide Source: Rebecca Moore, PlanSponsor, 8/25/2011, PlanSponsor Article
Case: Baker v. Pennsylvania Economy League Inc. Retirement Income Plan, E.D. Pa., No. 2:10-cv-06738-AB, 8/23/11
Editor’s Note: While the subject of case is a pension plan, the court’s ruling against plan administrator and fiduciary breach has application for self-funded ERISA plans. Court rules that plaintiff./ claimant could continue with her claim against plan administrators’ actions constituted a fiduciary breach. (more…)
Category: ERISA, Pennsylvania, Plan Language, Self-Funding |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
A recent decision by a U.S. appeals court upheld a recovery in which a plan dealt directly with the auto liability insurer to achieve a recovery. The case is Shaffer v. Rawlings Co., 2011 WL 1977252 (6th Cir., May 18, 2011). (more…)
Category: 6th, ERISA, Reimbursement |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
We are familiar with cases holding that state laws limiting reimbursement to self-funded ERISA health plans from tort settlements or judgments through the madewhole, common-fund and collateral source rules are preempted by ERISA. However, we are not familiar with cases where there is a conflict between the right of a self-funded ERISA health plan to recover the benefits it paid under its plan provisions and the right of a hospital to recover its unpaid costs through a state statutory lien. We now have a case that discusses and resolves that conflict. The case is Osterman v. Smith, 2011 WL 1343056 (C.D. Ill., March 17, 2011). (more…)
Category: ERISA, Self-Funding, State Law |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
We’ve seen many cases where a self-funded ERISA health plan successfully recovers the benefits it paid from tort settlement proceeds, but we haven’t seen many cases where the plan also recovers its own attorney’s fees. American courts generally follow the practice that each party to a lawsuit bears the costs it incurs, whether it wins or loses the case. However, it’s not impossible for a successful litigant to recover its own legal fees from its unsuccessful opponent. (more…)
Category: ERISA, Legal, Self-Funding |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
By Jack B. Helitzer, Esq.
This issue of the Newsletter features a unique legal strategy used by a participant’s attorney who claimed that the auto liability insurer and the plan abused a plan member’s protected health information (PHI), when pursuing a subrogation claim. That approach raises the question of how plans can prevent subrogation situations from violating privacy laws. Well-drafted summary plan descriptions (SPDs) should include the plan’s privacy policies, including when PHI may be disclosed. One feasible approach may be for the plan’s subrogation and reimbursement provisions to cross-reference to the plan’s privacy provisions, and to have those provisions state that PHI can be shared with other insurers for benefits coordination. In addition, the plan’s privacy provisions should state that PHI may be disclosed to support a reimbursement claim. (more…)
Category: ERISA, PHI, Subrogation, Summary Plan Description |
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cmonfils | August 22, 2011
The Self-Insurer August 2011
From the Bench Michael Friedman and John Eggertsen
The U.S. Supreme Court, in GIGNA Corp v. Amara, et al., 563 U.S., 2011 WL 1936077 (May 16, 2011), revisited, and likely expanded, the scope of equitable remedies available under ERISA § 502 (a)(3). The Court also rejected Plaintiff’s effort to sue under the terms of the SPD as opposed to the terms of the actual ERISA plan document. (more…)
Category: 9th, ERISA, Summary Plan Description, Supreme Court |
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cmonfils | August 22, 2011
www.myhealthguide.com
MyHealthGuide Source: Dick Goff, published in TortSource, A Publication of the Tort Trial & Insurance Practice Section, Summer 2011, Vol. 12, No. 4 via Passion for Subro, The Health Insurance Blog of Attorney Adam V. Russo.
Funding employee benefit plans through a captive insurance company (a privately owned insurance company that insures the risks of its parent company) has always seemed like a good idea to corporate America, but now it is becoming a vital one. Unfunded health care for the fast-growing retired population is the elephant in the corner of the executive suite–it’s becoming too big to move and too expensive to feed. (more…)
Category: ERISA, Health Insurance, Self-Funding |
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cmonfils | August 15, 2011
www.erisalawyerblog.com By Stanley D. Baum August 4, 2011
In Malkani v. Clark Consulting, Incorporated, No. 10-2008 (4th Cir. 2011) (Unpublished Opinion), the Fourth Circuit Court of Appeals reminds us about who can sue under ERISA. (more…)
Category: 4th, ERISA |
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cmonfils | July 25, 2011
Plaintiff, injured in a car accident, must reimburse his insurer for medical expenses under the language of his ERISA benefits plan.
By Joe Forward, Legal Writer, State Bar of Wisconsin
July 12, 2011 – Under an Employee Retirement Income Security Act (ERISA) benefits plan, an insurer was entitled to reimbursement amounts it paid to cover a beneficiary’s medical expenses, even though the beneficiary was not made whole through settlement, the Wisconsin Supreme Court recently concluded. (more…)
Category: ERISA, Reimbursement, Wisconsin |
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cmonfils | July 25, 2011
www.myheat;hguide.com
MyHealthGuide Source: Thomas Croft, Esq., King & Croft LLP, 7/20/2011, www.StopLossLaw.com
Case: Woodruff & Sons, Inc. v. The Covenant Services Group, Inc., No. 8:11-cv-1096, in the United States District Court for the Middle District of Florida, July 12, 2011). Court’s Opinion
Mr. Croft’s Comment: This state law based case was filed against a TPA for allegedly failing to meet a stop loss policy deadline for the filing of an aggregate claim, with the result that the claim was denied. The defendant TPA moved to dismiss the Complaint against it, arguing that ERISA pre-empted the group’s state law claims. (more…)
Category: ERISA, Stop Loss, Third Party Administrators |
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cmonfils | July 11, 2011
www.ftwilliam.com 7/7/2011
On June 24, 2011 the IRS (Internal Revenue Service), DOL (Department of Labor) and DHHS (Department of Health and Human Services) jointly published an amendment to the interim final rules on rules relating to internal claims and appeals and external review processes. Along with the new rules (on June 22) the departments also issued Technical Release No. 2011-02 and revised model notices (Revised Model Notice of Adverse Benefit Determination, Revised Model Notice of Final Internal Adverse Benefit Determination, Revised Model Notice of Final External Review Decision). The new guidance and new notices came just one week before the benefit denial notice requirements are no longer under an enforcement grace period (scheduled to end the first plan year beginning on or after July 1, 2011). (more…)
Category: DOL, ERISA, External Claim Review, Health Care Legislation, HHS, Self-Funding |
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cmonfils | July 11, 2011
www.fordharrison.com 6/29/2011
Executive Summary: Specifically overruling the holdings of four prior decisions, a full panel of the Ninth Circuit has held that ERISA permits the beneficiaries of an employee benefits plan to sue parties other than the plan administrator to recover benefits due under the plan. See Cyr v. Reliance Standard Life Insurance Company (9th Cir. June 22, 2011). (more…)
Category: 9th, ERISA |
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cmonfils | July 4, 2011
www.workforce.com June 27, 2011
The 9th U.S. Circuit Court of Appeals circuit court June 23 decided that retirement-plan participants can sue third-party insurers under the Employee Retirement Income (more…)
Category: 9th, ERISA |
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