Archive for the ‘Texas’ Category

Texas House Bill 4095 seeks to limit group health and accident plan subrogation rights. Specifically:

(1) subordinate an insurer’s subrogation rights to its insured’s right to recovery;

(2) mandate an insurer share in the legal expenses to the same extent the insurer shared in the insured’s recovery;

(3) deny an insurer’s right to recover against its insured’s first party recovery;

(4) require all injured individuals be “made whole” before any subrogation recovery.

by Ron E. Peck, Esq.

In the case of Osborne v. Jauregui, Inc., the Texas Court of Appeals, Third District at Austin, has enforced the holding of Fortis Benefits v. Cantu, 234 S.W.3d 642 (Tex. 2007), and espoused an anti-double recovery policy, (Tex.App. – Austin, Aug. 29, 2007 & April 17, 2008 – No. 03-04-00813-CV).  This represents yet one more victory for subrogating insurers, and those that hope to see the costs of insurance remain within reason. Read more

The Texas Made-Whole Rule, adopted in Ortiz v. Great Southern Fire & Casualty Insurance Co., no longer applies to cases where the Plan disclaims the rule and requires full reimbursement in the plan document. 597 S.W.2d 342, (Tex. 1980). In the Ortiz case the insurance carrier relied upon arguments made in equity. The court held that health plans do not have an equitable right to recovery until the plan beneficiary is fully compensated. Id. Read more