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 [...]
Adam V. Russo | June 17, 2010
Texas Health Insurance Risk Pool v. Sigmundik, 2010 WL 2136625 (Tex. 2010)
The self insured industry got a big subrogation win. In a very pro-subrogation opinion, the Texas Supreme Court declared that a trial court abuses its discretion when it invokes the equitable “Made Whole” Doctrine to circumvent a party’s contractual right to subrogation. The Court [...]
Adam V. Russo | June 15, 2010
As you know, the recent Fortis case in Texas said that if a plan document excludes made whole rule (and presumably, other equitable doctrine such as the common fund doctrine), the contract language trumps the equitable doctrine.
The Texas Supreme Court recently struck another big victory for subrogation in its Health Insurance Risk Pool v. Sigmundik, [...]
Adam V. Russo | June 7, 2010
MyHealthGuide Source: StreetInsider.com, 6/2/2010,
AUSTIN, TX — The Texas Supreme Court has declined to review a case involving the amount some hospitals marked up workers’ compensation-related bills under rules in effect until 2008.
“Texas employers realized a great victory today,” Mary Barrow Nichols, general counsel and senior vice president for Texas Mutual, said. “A small number of [...]
Adam V. Russo | May 21, 2010
By TODD ACKERMAN HOUSTON CHRONICLE
Texas doctors are opting out of Medicare at alarming rates, frustrated by reimbursement cuts they say make participation in government-funded care of seniors unaffordable.
Two years after a survey found nearly half of Texas doctors weren’t taking some new Medicare patients, new data shows 100 to 200 a year are now ending [...]
Adam V. Russo | May 21, 2010
by Emily Ramshaw
Prudie Orr is a licensed psychiatric nurse practitioner, but these days she feels more like an aspiring indentured servant. Since moving to the Central Texas town of Georgetown in December, she’s been unable to open a practice and see patients — because she can’t find a doctor who will allow it. “I’ve gone [...]
Adam V. Russo | April 6, 2010
By DAVE MICHAELS / The Dallas Morning News
WASHINGTON – The landmark health care law approved this week was sold as an effort to reform unfair insurance practices, but it largely exempts the existing employer-based network from the overhaul.
The law grandfathers many existing employer-sponsored plans, sparing them from the consumer protections that will apply to new [...]
Adam V. Russo | November 13, 2009
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 [...]
Adam V. Russo | April 21, 2008
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 [...]
Adam V. Russo | November 13, 2007
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 [...]
