bhoffman | August 25, 2010
Coordination of Benefits Handbook
The government has yet to sort out the conflicting interests involved in subrogation/reimbursement dispute. Because there will be no reform body directly creating subrogation/reimbursement rules, the matter remains one of balancing various laws. For instance, laws in many states limit plans’ ability to recover health expenses based on the “make-whole,” “collateral source” [...]
bhoffman | August 25, 2010
By Jack B. Helitzer, Esq., Coordination of Benefits Handbook
The federal health care reform law attempted to address two major problems with health coverage in the United States; (1) expansion of coverage to the uninsured; and (2) reducing overall health care costs. Most reform provisions won’t take effect for at least a few years. That’s because [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Victims of accidents in subrogation/reimbursement cases have emotional appeal when they argue that tort settlements are reduced without some consideration of the fact that they were not “made whole” or had their recoveries diminished by not requiring a recovering plan to share the legal fees they incurred in making the settlement. There [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Although federal case law is well settled on the principle that an ERISA health plan is entitled to reimbursement of benefits paid from tort settlement proceeds that are clearly identified as such, it appears that attorneys for plan participants still come up with several arguments seeking to avoid such liability. Those arguments [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
As we have often seen in cases involving tort settlement proceeds arising from auto accidents, Michigan’s no-fault auto insurance law (Mich. Comp. Laws §500.3135) provides that Michigan drivers can buy secondary no-fault coverage at lower premiums. The law prevents insured health plans issued in Michigan from seeking reimbursement for medical expenses from [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
We are familiar with cases where ERISA and state laws conflict. As we know, self-insured health plans that are subject to ERISA may avoid the application of state laws because of ERISA preemption. As we have seen in our analysis of the case Bash v. State Farm Mutual Automobile Insurance Co. on [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
The California Penal Law §202.4(f) requires that anyone who is found guilty of a criminal act that results in harm to a victim to provide restitution for economic losses incurred by the victim. A recent decision by a California Court of Appeal required such restitution based on the billed medical expenses incurred [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
In a case that does not involve a health plan subject to ERISA, a Florida appellate court ruled that a health plan’s reimbursement from the proceeds of a settlement of a medical malpractice case was limited to the amount paid by the plan less its pro-rata share of attorney’s fees incurred by [...]
bhoffman | 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 [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Alabama’s collateral source rule statute has been through a turbulent history since it was enacted in 1987. In 1996, the Alabama Supreme Court ruled that the statute violated the due process and equal protection guarantees of the Alabama Constitution. However, in 2000, the Alabama Supreme Court reversed its earlier decision holding that [...]
bhoffman | July 20, 2010
By Daran P. Keifer, Kreiner & Peters Co.
2009 was a rough year for subrogation rights in the United States, as we saw many more bills across the various states and even in Congress, which sought to undermine or eliminate subrogation rights. NASP continues to expand its influence as the premier resource for education about “subrogation” [...]
Adam V. Russo | June 28, 2010
NASP, www.subrogation.org
Florida attorneys and recovery specialists should be aware that the Florida Bar Association Board of Governors is looking to adopt a rule change to the fee limits that are placed on contingency fees that will allow attorneys who fight against subrogation liens to charge a fee separate from or in excess of the contingency [...]
Adam V. Russo | June 17, 2010
As you may have heard, a law was just passed in Colorado which devastates subrogation and reimbursement efforts in that State, under State law. This only applies to fully funded insurance carriers, and self-funded benefit plans which obey State law, such as governmental entities and houses of worship.
Not only does C.R.S. § 10-1-135, which will [...]
Adam V. Russo | May 26, 2010
Very strange case where the plan participant never appears to defend herself against the efforts of the plan to obtain a judgment imposing a constructive trust or equitable lien against tort settlement proceeds. The case is ACS Recovery Services, Inc. v Kaplan, 2010 WL 144816 (N.D. Cal., Jan. 11, 2010)
Adam V. Russo | April 29, 2010
This case is extremely important as it stands for premise that the Plan expects premium payments and subro rights in exchange for paying benefits. Specifically, it states that subrogation defrays health insurance costs. The Defense made an argument stating that Zurich’s claim for reimbursement violates ERISA’s anti-discrimination provision but Court disagreed stating that plan language [...]
