bhoffman | August 25, 2010
Coordination of Benefits Handbook
Although federal case law is well settled on the principle that an ERISA health plan is entitled to reimbursement of benefits paid from tort settlement proceeds that are clearly identified as such, it appears that attorneys for plan participants still come up with several arguments seeking to avoid such liability. Those arguments [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
As we have often seen in cases involving tort settlement proceeds arising from auto accidents, Michigan’s no-fault auto insurance law (Mich. Comp. Laws §500.3135) provides that Michigan drivers can buy secondary no-fault coverage at lower premiums. The law prevents insured health plans issued in Michigan from seeking reimbursement for medical expenses from [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
We are familiar with cases where ERISA and state laws conflict. As we know, self-insured health plans that are subject to ERISA may avoid the application of state laws because of ERISA preemption. As we have seen in our analysis of the case Bash v. State Farm Mutual Automobile Insurance Co. on [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
The California Penal Law §202.4(f) requires that anyone who is found guilty of a criminal act that results in harm to a victim to provide restitution for economic losses incurred by the victim. A recent decision by a California Court of Appeal required such restitution based on the billed medical expenses incurred [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
In a case that does not involve a health plan subject to ERISA, a Florida appellate court ruled that a health plan’s reimbursement from the proceeds of a settlement of a medical malpractice case was limited to the amount paid by the plan less its pro-rata share of attorney’s fees incurred by [...]
bhoffman | August 25, 2010
Coordination of Benefits
The common-law collateral source rule is intended to ensure that a person who suffers a financial loss as a result of other person’s wrongdoing does not achieve reimbursement of more than 100 percent of the loss from all sources. In Ohio, the modern collateral source rule is governed by a statute that permits [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Medicare clearly has a right of reimbursement of payments it made for medical services when a third party is determined to have responsibility for those expenses. 42 U.S.C. 1395y(b)(2). New Jersey’s collateral source rule provides that if a person receives benefits for injuries from any source other than a joint tortfeasor, those [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Alabama’s collateral source rule statute has been through a turbulent history since it was enacted in 1987. In 1996, the Alabama Supreme Court ruled that the statute violated the due process and equal protection guarantees of the Alabama Constitution. However, in 2000, the Alabama Supreme Court reversed its earlier decision holding that [...]
bhoffman | August 25, 2010
SIIA, www.siia.org
Oklahoma Tax on Paid Claims Ruled Unconstitutional
This afternoon, a recently enacted tax that would have applied to all claims paid in Oklahoma by health plans, was struck down by the Oklahoma Supreme Court.
Earlier this summer, the Oklahoma State Legislature passed a measure, subsequently signed into law by the Governor, which would have assessed a [...]
bhoffman | August 12, 2010
CCH® BENEFITS, www.hr.cch.com
California
The California Public Employee’s Retirement System (CalPERS) has approved an average increase of more than 9% in health premiums next year for state and local government workers. CalPERS blamed the rate increase on rising costs for hospital care, doctor visits, and prescriptions. The increase will mean higher premiums for public agencies and their [...]
bhoffman | August 3, 2010
SIIA, www.siia.org
SIIA has protested to the Nevada attorney general against the state’s recent prohibition of insurance coverage issued by Alliance for Non-Profits for Insurance, Risk Retention Group (ANI), a SIIA member.
SIIA Chief Operating Officer Mike Ferguson wrote to Attorney General Catherine Cortez Mastro stating that the DOI ruling prohibiting ANI from issuing automobile liability coverage [...]
bhoffman | July 19, 2010
www.thompson.com
Health Net of Connecticut, Inc. agreed to pay $250,000 to resolve a HIPAA privacy lawsuit by the state of Connecticut that was the first to be filed under HIPAA’s recently added state enforcement powers. Connecticut Attorney General Richard Blumenthal had sued Health Net in January over a major data breach that the insurer suffered in [...]
Adam V. Russo | July 9, 2010
Business Insurance, www.businessinsurance.com
We’re disappointed that the Supreme Court ducked the opportunity to resolve the legality of “play-or-pay” laws once and for all.
As we report on page 4, the court last week declined to review a lower court decision upholding San Francisco’s health care spending law.
Adam V. Russo | July 9, 2010
In Kehoe v. 1st Source Bank Healthcare Benefits Plan,190 the court affirmed an ERISA plan administrator’s denial of health coverage where claimant had a blood alcohol level of 0.128, as tested at the treating hospital, and the plan excluded “[c]harges resulting from an illness or injury incurred while under the influence of alcohol or illegal [...]
Adam V. Russo | July 9, 2010
In the context of an ERISA claim in which the insurer’s structural conflict of interest was a factor in the court’s analysis, the court concluded the record was insufficient to determine if the insured’s drinking antifreeze was accidental in Catledge v. Aetna Life Insurance Co. The policy excluded loss “caused or contributed to by: an [...]
