cmonfils | December 30, 2011
We suggested a narrative earlier this year that two southern captive insurance domiciles would be worth watching to compare and contrast based on insurance commissioner appointments in each state. Let’s review.
The captive industry in South Carolina fell on hard times during the regime of Insurance Commissioner Scott Richardson who left office at the end of 2010. When newly-elected Governor Nikki Haley named David Black as his replacement in February, this blog reflected the puzzlement expressed by many industry and political insiders.
http://self-insuranceworld.blogspot.com/
Category: Health Insurance, South Carolina, Tennessee |
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cmonfils | November 20, 2011
Employer’s Guide to Self-Insuring Health Benefits
Thompson Publishing November 2011 Vol. 19, No. 2
A plan’s decision to circumvent its own written appeals procedures led to ERISA claims. In a dispute involving an experimental service denial, plan administrator Viacom and claims administrator United Healthcare told a plan participant to skip the plan’s normal appeals route and appeal to Viacom, because it might overrule the plan’s exclusion or revise the plan to allow payment for the service. When the plan sponsor fumbled its decision, gave conflicting explanations and took months to ultimately deny the claim, the participant sued alleging unpaid benefits, breach of fiduciary duty and other charges. United managed to get all breach of fiduciary duty charges waived but the Viacom defendants still have to face all charges. Wrongful denial of benefits charges still stand against both defendants. (more…)
Category: Claims Review, ERISA, PPACA, Tennessee |
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cmonfils | September 19, 2011
www.myhealthguide.com
MyHealthGuide Source: MyHealthGuide Source: Thomas Croft, Esq., King & Croft LLP, 9/15/2011, www.StopLossLaw.com
Case: Clarcor, Inc. v. Madison National Life Insurance Co., No. 3:10-189, in the United States District Court for the Middle District of Tennessee, 9/2/2011. Court’s Opinion.
In ruling on a motion filed by the group, Clarcor, to alter or amend (in essence to reconsider and set aside) the Court’s earlier judgment in this case, the Court faced the issue whether the Madison National stop loss policy’s exclusion for untimely offers of COBRA barred Clarcor’s claims regardless of the eligibility issues dissected and discussed in the Court’s first opinion. In a September 2, 2011 opinion, the Court recognized the effectiveness of the exclusion: (more…)
Category: Stop Loss, Tennessee |
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cmonfils | September 9, 2011
The Self-Insurer September 2011
From the Bench By Thomas A. Croft
Clarcor, Inc. v. Madison National Life Inc. Co., No. 3:10-189, in the United States District Court for the Middle District of Tennessee, July 11, 2011.
Comment: The Court got this one right. Clarcor sued Madison National, the stop loss carrier, claiming that certain expenses paid by its Plan for the medical care of one of Clarcor’s employees were reimbursable under the stop loss contract. The employee, identified in the Court’s opinion only as “I.K.,” was last “regularly scheduled” to work on October 20, 2007. She elected FMLA, which preserved her eligibility through January 12, 2008. At the end of the FMLA period, I.K. was not offered COBRA, but was instead placed on “short-term disability” until June 23, 2008 when she was terminated and offered COBRA. Although not discussed in the Court’s opinion except in an oblique footnote, the Madison National stop loss policy appears to have had a “late COBRA” exclusion, based on a review of the parties’ briefing. (See Majestic Star Casino, LLC v. Trustmark Ins. Co. at www.stoplosslaw.com for an example of a judicial enforcement of a stop loss policy “late COBRA” exclusion). (more…)
Category: Stop Loss, Tennessee |
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Adam V. Russo | June 28, 2010
Tennessee. The state senate has approved a bill that will allow hospitals in the state to pay a fee to avoid $659 million in TennCare cuts. Gov. Phil Bredesen had proposed cutting $201 million from TennCare, the state’s Medicaid program, to help balance the state’s budget. The cuts would be averted through the hospital assessment. For more information, visit http://www.state.tn.us/tenncare/.
Category: Health Care Legislation, Medicaid, Tennessee |
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Adam V. Russo | June 28, 2010
Twenty states so far have rejected federal funds to administer a high-risk insurance pool, as designed by the Patient Protection and Affordable Care Act. The high-risk pool would extend coverage to state residents unable to purchase insurance because of preexisting medical conditions. In these states, the federal government will be responsible for creating and running a high-risk pool on behalf of the state, as mandated by the Affordable Care Act. The 20 states are: Alabama, Arizona, Delaware, Florida, Georgia, Hawaii, Idaho, Indiana, Louisiana, Minnesota, Mississippi, Nebraska, Nevada, North Dakota, South Carolina, Tennessee, Texas, Virginia, West Virginia, and Wyoming. Two states, Oregon and Utah, have not indicated whether they will be running their own high-risk pool or if they will let the HHS run it for them. The remaining 28 states have decided they will run their own temporary high-risk pool. For more information, visit http://www.hhs.gov/ociio/initiative/hi_risk_pool_facts.html. (more…)
Category: Alabama, Arizona, Delaware, Florida, Health Care Legislation, Oregon, Tennessee, Texas, Utah, Virginia, West Virginia, Wyoming |
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Adam V. Russo | January 25, 2010
For the last few years, states have been leading the way toward more comprehensive health care coverage to ensure that more people have or can obtain health insurance. Because of the potential impact of this ongoing activity on employer-provided health insurance benefits, Spencer’s Benefits Reports provides regular updates about state health care reform.
Tennessee. The state has cut off enrollment for two health insurance programs for low-income people: the CoverKids program, which is the state’s CHIP, and CoverTN, an insurance program designed for the self-employed and working poor. State officials say that with a projected $1.5 billion shortfall in the state’s $29 billion budget, there is no extra money to go around. For more information, visit http://www.covertn.gov/.
Category: Health Care Legislation, Tennessee |
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Adam V. Russo | October 6, 2008
When negotiations concerning a possible settlement of plaintiff’s subrogation claim failed, Ms. DeBoer demanded her share of the settlement, and the attorney defendants paid over to her the amounts they had recovered, less their counsel fees and expenses. In doing so, they carefully notified Ms. DeBoer of her obligation to repay the plaintiff’s subrogation claim, and obtained from Ms. DeBoer an agreement to indemnify them against any claims which might ensue because they had paid over the proceeds to her. The present lawsuit followed. (more…)
Category: 3rd, 6th, Pennsylvania, Provider Reimbursement, Tennessee |
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