Adam V. Russo | May 27, 2008
In two separate cases, courts have found that health plans may refuse to pay benefits if participants or their attorneys refuse to sign reimbursement agreements. Some attorneys refuse to sign such agreements because they believe the plan is not entitled to fulfill reimbursement under applicable law. However, in many cases, the plan then refuses to pay any further benefits. The two cases are Cossey v. Associates Health and Welfare Plan, 2008 WL 276282 (E.D. Ark., Jan. 30, 2008) and Metal Technologies v. Ramirez, 2008 WL 153534 (E.D Wis., Jan 11, 2008). (more…)
Category: 8th, Signed Subrogation Agreements |
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Adam V. Russo | November 28, 2007
There is a recent newsworthy item that I wish to discuss, as it is pertinent to our industry. The November 20, 2007 Wall Street Journal featured an extremely negative cover story, relating to the self-insured industry’s subrogation activities under ERISA. These types of prominent news stories do nothing for the self-insured industry except motivate the public to change current ERISA legislation. For those of you who do not know about this case, the story covers a woman’s collision with a semi-trailer truck seven years ago, leaving the 52-year-old Deborah Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, received a $700,000 accident settlement from the trucking company involved. After legal fees and other expenses, the remaining $417,000 was put in a special trust to be used for Mrs. Shank’s care. (more…)
Category: Claims Procedures, Claims Review, ERISA, Litigation, News, Provider Reimbursement, Signed Subrogation Agreements, Standings, Subrogation, Summary Plan Description, Third Party Administrators |
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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 the court determined the Plan’s conditioning payment of claims on the signing of a subrogation agreement was not supported by the summary plan document (“SPD”). The court held that the language of the SPD controls and additional agreements cannot create new rights for the Plan. (more…)
Category: 5th, Claims Procedures, Plan Language, Provider Reimbursement, Signed Subrogation Agreements, Subrogation, Summary Plan Description |
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