Archive for the ‘Texas’ Category

Texas State Courts Share Pro-Subro Sentiment

April 21, 2008 | Made Whole Rule, Subrogation, Texas | No Comments

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

Texas Made-Whole Rule Takes a Hit

November 13, 2007 | Attorneys' Fees, ERISA, Made Whole Rule, Plan Language, Provider Reimbursement, Summary Plan Description, Texas | No Comments

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