Adam V. Russo | August 31, 2009
From The Bench – The Self-Insurer Volume 26* August 2009
By John H. Eggertsen, Esq. and Michael Friedman, Esq.
II. Fifth Circuit Rejects Benefit Decision For Procedural Defects; Can’t Even Assess If Determination was Arbitrary And Capricious
In Lafleur v. Louisiana Health Service Indemnity Company, d/b/a Blue Cross Blue Shield of La., 563 F.3d 148 (5th Cir. 2009), [...]
Adam V. Russo | July 29, 2009
by Andrea Jackson, Times-News, www.magicvalley.com
A Twin Falls lawyer is fighting a lawsuit slapped against him by a former client claiming negligence, and has filed paperwork to dismiss the case in Twin Falls 5th District Court.
William Hollifield, of the Hollifield Law Office in Twin Falls, is being sued by Amanda Fomichev, a former client who hired [...]
Adam V. Russo | May 13, 2009
In Arnold v. Hartford Life Insurance Co.( 542 F. Supp. 2d 471 (W.D. Va. 2008), Hartford denied a beneficiary’s claim for accidental death benefits, concluding that the insured’s death was not due to an “injury” as defined in the policy. The insured died at the scene of a motorcycle crash. The immediate cause of death [...]
Adam V. Russo | December 29, 2008
In Avmed, Inc. V. BrownGreer, PLC, 2008 WL 4909535 (5th Cir. 2008), the 5th Circuit Court of Appeals hurt the health insurance subrogation industry when it comes to Vioxx claims. The court recognized that ERISA health plans have legitimate rights of subrogation and reimbursement for medical expenses paid to participants who suffered health issues after [...]
Adam V. Russo | November 11, 2008
Most lawsuits to recover damages in car accidents are resolved in state courts. State courts will order that at least a portion of the judgment be deposited into court when it appears that a health plan may have the right to reimbursement. But can a state court override the right of the health plan to [...]
Adam V. Russo | September 26, 2008
On September 22, 2008 the Fifth Circuit issued its decision in Young v. Wal-Mart Stores, Inc., et. al.
The case involved an ERISA claim for accidental death and dismemberment (AD&D) benefits in the amount of $25,000. The decedent suffered from a history of severe hypertension. He stopped taking his medication, became very ill and began vomiting [...]
Adam V. Russo | July 14, 2008
You may have heard some grumbling about the recent case of Amschwand v. Spherion Corp., 2007 U.S. App. LEXIS 24435 (5th Cir. 2007). The facts of the case are as follows:
Thomas Amschwand was a participant in his employer’s ERISA benefits plan, which included life insurance benefits. The employer switched insurers after Thomas Amschwand was diagnosed [...]
Adam V. Russo | May 27, 2008
ERISA did not preempt a Louisiana Department of Insurance directive that limits insurer’s subrogation and reimbursement rights to cases where covered individuals have been “made whole”, the 5th U.S. Circuit court of Appeals ruled in Benefit Recovery Inc. v. Donelon, 2008 WL 642972 (5th Cir. March 11,2008).
Adam V. Russo | April 22, 2008
If the summary plan description (SPD) omits important provisions, such as subrogation and reimbursement, that are included in another document, the plan may not be able to compel beneficiaries to follow those provisions. In one such case, a federal judge shot down a plan’s denial after a participant refused to sign a subrogation agreement. The [...]
Adam V. Russo | March 26, 2008
Benefit Recovery, Inc. sued Louisiana Commisioner of Insurance and lost its case. See entire 5th Circuit Court of appeals decision.
Adam V. Russo | March 14, 2008
A Louisiana State Law requiring that insureds be made whole before an insurance carrier could seek reimbursement was upheld by the 5th Circuit, Benefit Recovery, Inc. v. Donelon, 2008 WL 642972 (March 11, 2008). Note that the decision only applies to plans that are not self-funded, but will apply to plans that are fully insured, [...]
Adam V. Russo | November 13, 2007
The United States District Court for the Eastern District of Texas recently presided over a case involving a plan’s denial of claims due to a lack of signed subrogation agreement. Don Burgett, Et. Al. v. MEBA Medical and Benefits Plan, 2007 U.S. Dist. LEXIS 70934, (September 25, 2007). The Plan in this case lost, and [...]
