Archive for the ‘Ohio’ Category

The Ohio Bar Association’s new Subrogation Committee held its first meeting today to try to formulate what the purpose of this committee is. The committee developed a working statement which states as follows: “Parties injured by a wrongdoer often are not receiving full or fair compensation in part because of subrogation laws of Ohio.” The Committee does contain one subrogation attorney Dennis Rehor of Cincinnati Insurance company. The Committee will attempt to reconvene to discuss this statement of principle on April 14th, 2010 at 10:30 A.M. The Ohio Bar Association hopes to have some proposals considered again at its meeting during its yearly convention in Dayton in early May. Ohio subrogation attorneys who are members of the OSBA need to make sure they check the OSBA’s website regularly as they hope to post information regarding the work of this Committee.

MyHealthGuide Source: Meredith Z. Maresca, BNA’s Pension & Benefits Daily, 1/27/2010, www.bna.com

In a decision addressing identification of the proper defendant in a benefit claim action brought pursuant to the ERISA’s civil enforcement provision, the U.S. District Court for the Southern District of Ohio held that the health plan’s TPA potentially could be liable for the alleged wrongful denial of benefits to cover a beneficiary’s bone cancer treatment. Read more

By TIM HULL

(CN) – An insurance company must award benefits to an Ohio man who lost his leg in a drunken motorcycle crash, the 6th Circuit ruled, because the incident falls within the broad definition of an “accident.” Read more

From The Bench – The Self-Insurer Volume 26* August 2009

By John H. Eggertsen, Esq. and Michael Friedman, Esq.

After the U.S. Supreme Court’s recent decision in Metropolitan Life Ins. Co. v. Glenn ___ U.S.___, 128 S. Ct. 2343 (2008), many circuit courts have been applying a magnifying glass to their prior standard of review decisions, and making whatever adjustments they feel are necessary in light of this most recent guidance. We have discussed some of those cases in the past, and may do so again if circumstances warrant. In this discussion, however, we turn to a notable trend that had been emerging pre-Glenn, is continuing unabated and may be accelerating post-Glenn – that trend is the tendency of the courts to examine in greater detail the actual evidence on which claims determinations are based and the administrators’ rationales for making their determinations based on that evidence. Even under an arbitrary and capricious standard of review, generally held to be the most deferential standard, the courts are more willing to take the administrators’ word at face value. In addition, courts are scrutinizing claim determinations with an eye towards ERISA’s procedural requirements, and striking down those that fail to comply. The two cases discussed here are clear evidence of both these trends. Read more

by Andy Thompson, www.mariettatimes.com

The Ohio House of Representatives recently passed a budget bill that included yet another mandate for state-regulated health insurance plans – a mandate that falls squarely on the backs of the small business and individual policy holders that are already struggling with higher costs than other insured groups (self-insured companies, government plans and union-negotiated contracts are exempt from these mandates due to federal ERISA exemptions). Read more

by Friedman, Domiano, & Smith, Co., L.P.A., please visit us at http://www.fdslaw.com

In a tort action in Ohio, a defendant is barred from introducing evidence of insurance payments to a plaintiff. This is known as the collateral source rule. The objective of the collateral source rule is to prevent liable defendants from benefitting from payments made to the plaintiff by third parties. Read more

California

The California Assembly Health Committee recently passed a series of bills that will mandate expansion of specific benefits and health services for insurers. Benefits and services include mental health coverage (AB1877), screening and diagnostic test for gynecological cancer (AB1774), HIV testing (AB1894), maternity health care (AB1962), and breast cancer screening (AB 2234).  Insurance plans opposing bills argue that e increasing costs of the proposed mandates would total an estimated $2.7 billion annually and that 85,000 Californians would lose health insurance coverage because of the consequential higher premium costs. Read more