Archive for the ‘Mississippi’ Category

Shelby County Healthcare Corp, d/b/a Regional Medical Center v. The Majestic Star Casino, LLC group Health Benefit Plan, 2008 WL 782642 (WD Tenn.) has demonstrated that even though the SPD gives the Plan the final decision to accept or deny medical claims, discretion does not apply to the Plan’s TPA.Damon Weatherspoon, a plan participant of the Majestic Star Casino LLC Group Health Benefit Plan was involved in a single vehicle accident and sustained over $400,000 in medical expenses at the Regional Medical Center.  Reports indicated that Weatherspoon had violated Mississippi law by driving under the influence, driving without a valid Mississippi driver’s license and driving without insurance. Read more

Just when it appears that a well-drafted subrogation and reimbursement provision of an ERISA group health plan takes precedent over state-law restrictions on the plan’s recovery, we find that the Supreme Court of Mississippi has ruled that ERISA does not preempt a state law that requires approval of a Mississippi court regarding the allocation of a minor’s settlement proceeds from a tort claim. The case is In re Guardianship of Danielle Holmes, 2007 WL 2792491 (Sup. Ct., Miss., Sept. 27, 2007).

Rashan Danielle Holmes, a minor, was injured in an auto accident. She was covered under her mother’s employer’s self-insured ERISA plan, which included a well drafted subrogation and reimbursement provision. The plan made an advance payment of about $46,000 toward her medical expenses. Her claim against a third party was settled for $750,000, the plan asserted a subrogation lien against the proceeds and the amount advanced pending settlement of its claim for reimbursement. Read more

In the case of Bauhaus USA, Inc. v. Lillie Regina Holmes Copeland, et. al., 2007 Miss. LEXIS 545 (September 27, 2007), a self-funded Plan coming under the purview of ERISA sought reimbursement of claims it had paid on behalf of a minor child. The court took possession of funds in order to create a trust and use the funds to protect the minor. Read more