cmonfils | March 30, 2012
Maine LD 1769/HP 1303: In a positive development Maine enacted HP 1303, which repealed the anti subrogation law that prohibited subrogating for medical payments under a casualty insurance policy when claim are $20,000 or less.
cmonfils | March 30, 2012
Louisiana House Bill 697: On March 12, 2012, the Louisiana House of Representatives introduced Bill 697, which provides for lawsuits against third parties in workers’ compensation claims. Specifically, the proposed legislation would:
· Limit a subrogated insurer’s recovery to the amounts paid (or obligated to be paid), regardless of the amount recovered by the injured party;
· Affirm that a workers’ compensation insurer is entitled to a credit for the employee’s recovery of lost wages and medical benefits only, not for any other recovery by the employee (such as damages for pain and suffering);
· Provide for the distinction of special and general damages in any settlement of a third party claim;
· Set penalties for an employer or insurer who unreasonably withholds consent to a compromise settlement (penalty equals 12% of the compensation lien or $8,000, whichever is greater); and
· Importantly, the employer’s first dollar right of recovery without regard to how damages have been itemized by a judge or jury is eliminated. The bill would limit the employer’s first dollar right of recovery to only those amounts awarded for lost wages and medical benefits.
The Louisiana House Legislative Services’ digest claims that the proposed legislation merely “clarifies” existing law, but subrogation professionals would be well cautioned to pay particular attention to the limitations on subrogation recovery mentioned above. For example, under existing law, satisfaction of a lien or subrogated claim would be given first priority out of the judgment “without regard to how damages have been…classified by the judge or jury.” This “first dollar satisfaction” is currently paid to the insurer from the judgment “whether or not the judgment includes compensation for losses other than medical expenses or lost wages.” The proposed changes, however, explicitly restrict subrogation recovery to amounts specifically earmarked as damages for lost wages or medical expenses.
Louisiana House Bill 697: On March 12, 2012, the Louisiana House of Representatives introduced Bill 697, which provides for lawsuits against third parties in workers’ compensation claims. Specifically, the proposed legislation would (more…)
cmonfils | March 30, 2012
Connecticut Senate Bill 422: Currently in the Committee on Judiciary, Senate Bill 422 is an attempt to revise the methodology used for calculating an employer’s reimbursement for workers’ compensation benefits paid out when the injured employee recovers damages in an action against a third-party tortfeasor. (more…)
cmonfils | February 6, 2012
On-site clinics utilized in conjunction with a group health plan are becoming an increasingly common method to help employers address the rising cost of health care. The issues in implementing an on-site clinic may seem obvious: Finding a service provider; installing an appropriate facility; and addressing employee access during work hours. However, there are less obvious but equally important compliance concerns that arise when an on-site clinic is implemented. Such clinics maintained on an employer’s premises for “treatment of minor injuries or illness or rendering first aid in case of an accident during working hours” are exempt from the reporting and disclosure requirements of ERISA and other federal mandates such as COBRA. However, to the extent that employer-provided on-site clinics provide services beyond treatment for minor injuries and first aid, they are a means of providing medical care, and the requirements of federal law are important considerations for employers to address in adopting on-site clinic benefits.
cmonfils | January 5, 2012
MyHealthGuide Source: The Self-Insurance Institute of America, Inc. (SIIA), 12/15/2011, www.SIIA.org (Article provided again from last week’s MyHealthGuide Newsletter as background reference to above article.)
Case: Holdings, Inc. v. Baylor Health Care Systems (more…)
cmonfils | December 2, 2011
In 1989 and 1990, federal courts ordered two hospitals in Rockford, Ill., to stop merger talks after concluding that the combined organization would threaten competition and gain too much clout at the bargaining table with insureres.
http://www.modernhealthcare.com/article/20111128/MAGAZINE/311289947
cmonfils | October 3, 2011
www.myhealthguide.com
MyHealthGuide Source: Brent Kendall and Laura Meckler, 9/28/2011, Wall Street Journal Article for Online Subscribers
The Justice Department’s petition asking the Supreme Court to consider the constitutionality of the Obama administration’s health-care overhaul comes more than a month before its due date. In addition, the petition increases the chances that the justices will agree to consider the law during their coming term, which begins next week and runs through June 2012. (more…)
cmonfils | September 27, 2011
cmonfils | September 19, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
Contrary to two recent decisions, a health plan in New York failed in its effort to intervene in a plan participant’s lawsuit against a third party, which would have let the plan in on settlement negotiations or made it a party to the court’s allocation of the settlement proceeds. A recent decision, Robles v. Bruhns, 2011 WL 1564649 (N.Y. Sup. Ct., Suffolk Cty., April 26, 2011), refused to allow such an intervention. (more…)
cmonfils | September 16, 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…)
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…)
cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Just because a strategy to avoid reimbursing a health plan is unique does not mean it is going to prevent a plan from getting a full recovery. In one such case, attorneys argued against the plan getting relief based on a U.S. Supreme Court decision that federal courts have discretion to stay or dismiss an action based on considerations of “wise judicial administration, giving regard to conservation of judicial resources and comprehensive disposition of litigation.” (The ruling had nothing to do with health benefits). The court rejected this, finding no exceptional circumstances to warrant dismissal under that decision. In the other ruling, a participant tried to conceal the existence of a giant payoff but blundered spectacularly by enclosing a copy of $475,000 settlement check in a letter telling the plan that his client got only a $25,000 settlement. (more…)
cmonfils | July 11, 2011
Matthiesen, Wickert & Lehrer, S.C. June 2011 Newsletter
Matthiesen, Wickert & Lehrer, S.C. (MWL) has authored and filed an amicus curiae brief on behalf of the National Association of Subrogation Professionals (NASP) in the 9 Circuit case th of CGI Technologies and Solutions, Inc. Welfare Benefit Plan v. Rhonda Rose and Nelson Langer Engle, PLLC. Ryan Woody and Tim Mentkowski authored the brief, which turned out to be a powerful defense of subrogation generally, and health insurance subrogation specifically. (more…)
cmonfils | July 4, 2011
www.healthsubrogationblog.com Posted on June 29, 2011 by Tom Lawrence
In the third post in this series, I explained why the most effective healthcare subrogation companies are those with experience and a proven track record. In this post, I will explain why it is so important for a healthcare subrogation vendor to understand healthcare subrogation from a legal perspective. (more…)
