cmonfils | March 24, 2011
www.sfgate.com Saturday March 19, 2011
Hanover Park, IL (Vocus/PRWEB) March 18, 2011
On March 17, 2011, the provider plaintiffs in PCA v. BCBSA Et Al Class Action Lawsuit (Case: 1:09-cv-05619), filed motion to certify class in Northern District Court of Illinois, seeking for remedies in Injunctive Relief, asking Federal Court to find that Federal law ERISA govern BCBS overpayment dispute; 23 BCBS entities violated ERISA in their overpayment recoupment; and BCBS must comply with ERISA in all future overpayment recoupment, and more importantly, BCBS entities must refund all providers all of the money recouped in any violative practice. This motion was filed after the Court ruled, on May 17, 2010, that the plaintiffs ERISA class action may proceed against 23 BCBS entities, rejecting defendant BCBS state law and provider contract arguments under ERISA complete State law pre-emption ruling by U.S. Supreme Court. (more…)
Category: ERISA, Provider Reimbursement |
No Comments »
Tags:
cmonfils | March 11, 2011
Claim Recovery Specialist
This position entails speaking with insureds, investigating accident details, and handling insurance cases for potential recovery opportunities. The position also involves interacting with attorneys, providers, and/or insurance adjusters on subrogation and reimbursement cases across the country. The ability to prioritize tasks and balance work demands with timeliness and accuracy of results is a must. The Claim Recovery Specialist must also demonstrate organizational skills, excellent writing skills and must be able to effectively manage a demanding caseload. Must have a college degree with a 3.5 GPA and Spanish speaking a plus. (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | March 11, 2011
Paralegal
The Phia Group, LLC is a thriving, service-oriented company representing health insurance carriers nationwide. We seek to provide our clients with innovative cost saving solutions, and are constantly expanding our service offerings. We continue to enjoy growth thanks to our passion, as well as a belief that our talented and committed team is our most valuable resource. Now, we seek to add another Paralegal to that team. (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | March 11, 2011
Attorney
The Phia Group, LLC is a thriving, service-oriented company representing health insurance carriers nationwide. We seek to provide our clients with innovative cost saving solutions, and are constantly expanding our service offerings. We continue to enjoy growth thanks to our passion, as well as a belief that our talented and committed team is our most valuable resource. Now, we seek to add another Attorney to that team. (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | March 1, 2011
www.healthplanlaw.com
February 21, 2011 • Roy Harmon III
In Comrie v. IPSCO (7th. Cir. 2/18/11) the Seventh Circuit considered whether a discretion-conferring clause in a SERP plan document should be applied when the plan administrator is not a fiduciary. Noting a difference of opinion on the issue, the Seventh Circuit, via Judge Easterbrook, saw the issue as very simple to resolve: (more…)
Category: 7th, 8th, ERISA |
No Comments »
Tags:
cmonfils | March 1, 2011
www.eric.org
February 22, 2011
Washington, D.C. — The ERISA Industry Committee (ERIC) on February 22 submitted comments to the Commodity Futures Trading Commission (CFTC) and Securities and Exchange Commission (SEC) on proposed rules defining “major swap participant” and “major security-based swap participant” under the Dodd-Frank Wall Street Reform and Consumer Protection Act. The CFTC and SEC issued the proposed rules on December 21, 2010. (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | March 1, 2011
Thompson Publishing January 2011 Volume. 19, No. 1
As we have often pointed out, Michigan law provides that no-fault auto insurance is secondary to health plans. However, a long line of cases involving that statute establishes that ERISA preempts the Michigan law’s application to self-insured ERISA health plans. A recent opinion by a U.S. District Court in Michigan confirms preemption despite some interesting arguments made by the no-fault insurer. (more…)
Category: ERISA, Michigan |
No Comments »
Tags:
cmonfils | March 1, 2011
Thompson Publishing January 2011 Volume. 19, No. 1
New York late in 2009 barred subrogation and reimbursement rights for insured health plans. While it seems clear that the New York law does not apply to self-insured ERISA health plans, a health insurer’s preemptive attempt to force the issue was rejected by the U.S. District Court for Western New York. Citizen suits against states are barred by the 11th Amendment of the U.S. Constitution, and a lawsuit to compel a government official is limited to targeting only the official who has purview for enforcement of the challenged provision — and then only if the official actively enforced it, the court said. New York’s Attorney General (now Governor) Andrew Cuomo (D) has done nothing to challenge any self-insured ERISA plan’s use of subrogation and has said he had no intention of doing so. (more…)
Category: ERISA, New York |
No Comments »
Tags:
cmonfils | February 18, 2011
www.healthplanlaw.com
February 15, 2011 • Roy Harmon III
Following up on an earlier post, the new claims appeals and review rules present some opportunities to claimants and concomitant risks to plans. PHS incorporate the existing claims regulation DOL Reg. Sec. 2560.503-1 into an augmented claims procedure for internal appeals. PHS Act § 2719 provides that plans and issuers must initially incorporate the internal claims and appeals processes set forth in 29 CFR 2560.503-1 and update these processes as required by the DOL. (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | February 7, 2011
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Coordination of Benefits Handbook, Thompson Publishing Group, 2/3/2011, www.thompson.com
Case: Lafferty v. Providence Health Plans, 2011 WL 127489 (D. Ore., Jan. 14, 2011) related to the fees; the underlying case was decided in April 2010.
Editor’s Note: The health plan in this case is not self-funded. However, ERISA is cited by the Court. Many self-funded plans deny coverage and payment for experimental treatment. This case shows the outcome of a specific case when payor denial decisions go beyond what is deemed acceptable.
Preface from Mr. Leeuwenburgh: This case may be instructive to see the boundaries for an experimental treatment denial. If the policy was explicitly stated — we’ll deny your whole episode of care if we unbundle it and find you used any part that was experimental — and if this plan had followed ERISA’s review and appeal procedures do you think the insurer could have justified its denial? (more…)
Category: ERISA, Federal Circuits |
No Comments »
Tags:
cmonfils | February 2, 2011
www.lawyersandsettlements.com
January 26, 2011. By LAS Newswire Email
Janesville, WI: A Department of Labor lawsuit against a Janesville, Wisconsin company is reportedly the result of an investigation into alleged violations of the Employee Retirement Income Security Act (ERISA), according to the Janesville Gazette.
The department has filed the lawsuit against Premier Vending and its president, accusing the company of using employee retirement contributions for itself, according to the news source. (more…)
Category: ERISA, Fiduciary |
No Comments »
Tags:
cmonfils | February 2, 2011
www.healthplanlaw.com
January 26, 2011 •
The second prong of the Pascack test is also satisfied. Plaintiff identifies no other “independent legal duty” that would support its claims. Plaintiff’s argument that this is a “rate of payment” case is of no avail. 6 Plaintiff admits that it has no contractual relationship with any Defendants. At the same time, it argues that its right to payment is dependent upon assignments of benefits. The amount of payment (i.e., the “rate”) at issue would necessarily implicate the rates in the ERISA plans under which Plaintiff claims it has received assignments. (more…)
Category: ERISA, Federal Circuits, Litigation, Preemption |
No Comments »
Tags:
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 |
No Comments »
Tags:
cmonfils | February 2, 2011
www.healthplanlaw.com
January 25, 2011 •
Adam B. Gartner, Fordham University – School of Law, has published a note, “Protecting the ERISA Whistleblower: The Reach of Section 510 of ERISA” in the Fordham Law Review, Vol. 80, Fall 2011. The Note “addresses the unresolved circuit split over the reach of ERISA’s whistleblower protection provisions.” (more…)
Category: ERISA |
No Comments »
Tags:
cmonfils | February 2, 2011
www.healthplanlaw.com
January 18, 2011
In the present case, the plaintiff asserts its procedural challenge on the grounds that, given the different versions of the administrative record produced during discovery, many of which lacked important medical records initially provided by the plaintiff, it is impossible to determine what comprises the full administrative record on which the defendants relied when denying the plaintiff’s claim. The Court concludes that this claim justifies discovery beyond the administrative record. The plaintiff’s allegation that the defendants may have failed to consider significant portions of the record may give rise to a procedural challenge of the kind discussed in Killian and may also give rise to an inference of a structural conflict of interest. (more…)
Category: Claims Procedures, Claims Review, ERISA, Litigation |
No Comments »
Tags:
