Adam V. Russo | November 18, 2010
MyHealthGuide, www.myhealthguide.com
Federal Court Chastises Stop Loss Carrier Over Efforts to Achieve Piecemeal Adjudication of Multiple Claims
MyHealthGuide Source: Tom Croft, Esq., King & Croft LLP, 11/10/2010 www.StopLossLaw.com
Case: Bekaert Corp. v. Standard Security Life Insurance Company of New York, Inc., No.5:09 CV 2903, in the United States District Court for the Northern District of Ohio, October 8, 2010) Court’s Opinion. (more…)
Category: Ohio, Stop Loss, Welfare Benefit Plans |
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Adam V. Russo | September 16, 2010
NASP, www.subrogation.org
NASP was invited to speak to the Ohio State Bar Association (OSBA) Subrogation Committee Meeting on September 14, 2010. NASP President Elect, Ken Levine, was in attendance and NASP Amicus Committee Chair, Daran Kiefer, represented NASP at this meeting, presenting written testimony that you can read on the NASP website at www.subrogation.org. (more…)
Category: Ohio, Subrogation |
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Adam V. Russo | September 7, 2010
MyHealthGuide, www.myhealthguide.com
By Tom Croft, Esq. of King & Croft LLP, www.StopLossLaw.com
Nationwide Life Ins. Co. v. City of Canton, Ohio, et al., No. 09AP-939, CPC No. 07CVH-08-11779 in The Court of Appeals of Ohio, Tenth District, 8/31/2010). Court’s Opinion
Mr. Croft’s comment: The myth that a stop loss carrier cannot win a disclosure dispute in court implodes yet again. This case involved a classic disclosure-issue fact pattern concerning a participant’s esophageal cancer, and a failure to make required disclosure on the part of the insured and one of its two TPAs. Relatively large dollars were involved. The Court of Appeals determined that the trial court had been correct in entering judgment for the stop loss carrier and its MGU. (more…)
Category: 10th, Ohio, Stop Loss, Welfare Benefit Plans |
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Adam V. Russo | 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 the alleged wrongdoer to “introduce evidence of any amount payable as a benefit to the [injured party] as a result of the damages that result from an injury, death or loss to person or property that is the subject of a claim upon which the action is based, except of the source of collateral benefits has… a contractual right of subrogation.” The Supreme Court of Ohio recently considered the application of the statute in determining how much the injured party received in benefits from his health insurer. The case is Jacques v. Manton, 2010 WL 1816324 (S. Ct. Ohio, May 4, 2010). (more…)
Category: Ohio, Subrogation |
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Adam V. Russo | 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 1.3 million employees, dependents, and retirees. For more information, visit http://www.calpers.ca.gov/. (more…)
Category: California, Connecticut, Health Care Legislation, Kansas, Louisiana, Maine, Massachusetts, New York, Ohio, Utah, Washington D.C., Wisconsin |
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Adam V. Russo | May 17, 2010
Case: Galion Community Hospital v. Hartford Life & Accident Ins. Co,, No. 1:08-cv-1635, in the United States District Court for the Northern District of Ohio, Eastern Division, May 7, 2010).
Mr. Croft’s Comment: This case involves two arguably conflicting provisions in an advance funding endorsement concerning the timing of submission of requests for advance funding:
To be eligible for advance reimbursement with respect to an Agreement year, Your request must be received by Us no later than the 10th calendar day following the end of that Agreement Year, provided the agreement is in force on the date we receive the request. (more…)
Category: 6th, Federal Circuits, Ohio, Stop Loss |
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Adam V. Russo | May 7, 2010
On May 4, 2010, the Ohio Supreme Court issued a decision in Jaques v. Manton, Slip Opinion No. 2010-Ohio-1838, and held that a defendant in a personal injury lawsuit is not barred by Ohio’s collateral source statute from introducing evidence of medical bill “write-offs” – the difference between the amount reflected on the medical bill and the negotiated amount accepted by the medical providers as payment in full. (more…)
Category: Ohio, Supreme Court |
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Adam V. Russo | March 3, 2010
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.
Category: Ohio, Subrogation |
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Adam V. Russo | February 1, 2010
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. (more…)
Category: 6th, ERISA, Ohio |
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Adam V. Russo | November 23, 2009
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.” (more…)
Category: Exclusion, Ohio, Plan Language |
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Adam V. Russo | August 31, 2009
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. (more…)
Category: 6th, MetLife v. Glenn, Ohio |
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Adam V. Russo | May 27, 2009
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). (more…)
Category: ERISA, Ohio |
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Adam V. Russo | April 27, 2009
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. (more…)
Category: Ohio |
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Adam V. Russo | June 13, 2008
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. (more…)
Category: California, Connecticut, Kansas, Nebraska, Ohio, Pennsylvania |
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