bhoffman | August 25, 2010
Coordination of Benefits Handbook
Victims of accidents in subrogation/reimbursement cases have emotional appeal when they argue that tort settlements are reduced without some consideration of the fact that they were not “made whole” or had their recoveries diminished by not requiring a recovering plan to share the legal fees they incurred in making the settlement. There [...]
Adam V. Russo | May 12, 2010
O’Hara contends that, as a matter of equity and in order to effectuate ERISA’s policy of protecting plan beneficiaries, the make-whole rule must be applied because allowing Zurich to recoup the medical expenses it paid on his behalf unduly punishes him by requiring him to forfeit a substantial portion of the compensation he received for [...]
Adam V. Russo | May 4, 2010
Colliers are in possession of the $ 70,000 and the fund is specifically identifiable and satisfying standard for relief under § 502(a)(3). The Court agreed that the Plan must be reimbursed.
Since the plan is a self-funded ERISA plan, federal law preempts Georgia’s anti-subrogation statute. In addition, the Plan had rejected the made whole doctrine in [...]
Adam V. Russo | April 29, 2010
This case is extremely important as it stands for premise that the Plan expects premium payments and subro rights in exchange for paying benefits. Specifically, it states that subrogation defrays health insurance costs. The Defense made an argument stating that Zurich’s claim for reimbursement violates ERISA’s anti-discrimination provision but Court disagreed stating that plan language [...]
Adam V. Russo | January 8, 2010
January 6, 2010 • HealthPlanLaw.com
While similar to the Butero test, Davila refines Butero by inquiring about the existence of a separate legal duty, which is not a consideration under Butero.
Moreover, a number of other circuits have recognized Davila’s two-part test as the proper test for complete preemption under ERISA . . . In accordance with [...]
Adam V. Russo | December 8, 2009
An employee’s spouse sued the insurer of her cancer insurance policy in state court after it refused to pay for medical treatment she had received. The insurer removed the case to federal court, arguing that her claim was preempted by ERISA. The spouse argued that the case belonged in state court because the policy fit [...]
Adam V. Russo | November 18, 2009
Well drafted subrogation provisions will state that any allocation of tort settlement or judgments to reimburse non-medical losses – such as earnings lost – will not be binding on the plan. If that is stated, settlements or judgments won’t preclude the plan participant’s obligation to reimburse the plan. However, that’s not the necessarily the case [...]
Adam V. Russo | May 13, 2009
The Ninth Circuit, in Daic v. Hawaii Pacific Health Group Plan for Employee of Hawaii Pacific Health, No. 06-17324, 2008 WL 3862074 (9th Cir. Aug. 13, 2008) analyzed whether MetLife, the insurer who administered the ERISA plan but was not a specifically names fiduciary, was nonetheless a plan fiduciary and whether, in light of Glenn [...]
Adam V. Russo | March 24, 2009
Since the Glenn decision, a number of circuits have had an opportunity to consider and apply the Glenn Court’s reassessment of ERISA’s standard of review.Roumeliote v. LTD Plan for Employees of Worthington Industries, 298 Fed. Appx. 472 (6th Cir. 9/11/2008).
This was the first circuit to apply Glenn since Glenn was a Sixth Circuit decision and [...]
Adam V. Russo | July 23, 2008
Diamond Crystal Brands, Inc. v. Wallace, 531 F.Supp.2d 1366 (N.D. Ga.2008)
After the negligent medical care and consequential death of Deborah Hayes, the Estate and her daughter Tamara Hayes pursued a wrongful death claim against the hospital. In Georgia State Court plaintiffs settled for $900,000, of which $837,000 went to Tamara Hayes and $63,000 to the [...]
Adam V. Russo | May 27, 2008
With the U.S. Supreme Court decision in Sereboff v. Mid Atlantic Medical Services, Inc., it became clear that ERISA plans can enforce their subrogation and/or reimbursement provisions by asserting a claim for a constructive trust or equitable lien against clearly identifiable tort settlement or judgment proceeds. In most instances, those proceeds end up either in [...]
Adam V. Russo | January 22, 2008
An employee health and welfare plan appealed a Northern District of Georgia decision in favor of defendants: a minor, a conservator of the minor, and a bank, in its action seeking to enforce reimbursement provisions of its ERISA Plan. The insured settled a personal injury suit and received funds from a liable third party. The [...]
