cmonfils | January 6, 2011
January 6, 2011
Anti-subrogation legislation was passed in the State of New York on November 12, 2009, which purported to eliminate the right of fully insured carriers and self-funded benefit plans, coming within the purview of state law, to pursue subrogation and reimbursement. We here at The Phia Group have never accepted anti-subrogation legislation without a fight. When we received word of the statutory shift, our attorneys immediately devised ways to enforce plan rights. (more…)
Category: New York, Subrogation |
No Comments »
Tags:
cmonfils | December 29, 2010
www.laborandemploymentlaw.ncbar.org
Article Date: Friday, December 17, 2010
Written By: Robert Ward Shaw & Mark Stanton Thomas
The U.S. District Court for the Eastern District of North Carolina recently held that the Employee Retirement Income Security Act of 1974 (“ERISA”) precludes a plan administrator with a claim against the insured for amounts recovered from a third party for medical benefits from pursuing equitable remedies against the insured attorney’s contingency fee award. (more…)
Category: 4th, Common Fund, Subrogation |
No Comments »
Tags:
Adam V. Russo | November 2, 2010
Sent from Daran Kiefer, Esq. of NASP, www.subrogation.org
The Chicago Bar Association is following the footsteps of the Ohio Bar as its Insurance Law Committee votes today at 1:00 P.M. Central Time whether to support a bill to limit health and medical payments subrogation rights in Illinois. This proposed change has been recommended by the Civil Practice Committee and is pending review by the Insurance Law Committee today. The Chicago Bar Association Legislative Liaison urged the committee members to vote against recommending the bill. (more…)
Category: Illinois, Subrogation |
No Comments »
Tags:
Adam V. Russo | October 14, 2010
Earlier today I had the pleasure of speaking at the SIIA 30th Annual National Education Conference & Expo held in Chicago, IL.
Click here to see my presentation on ”The Future of Subrogation & Reimbursement as a Cost Containment Strategy for Self-Funded Benefit Plans”.
Category: Subrogation |
No Comments »
Tags:
Adam V. Russo | October 8, 2010
If you plan on attending SIIA’s 30th Annual National Education Conference & Expo next week, don’t forget to stop by on October 14th for my presentation on “The Future of Subrogation & Reimbursement as a Cost Containment Strategy for Self-Funded Benefit Plans”.
I will post my entire PowerPoint presentation following my speech.
Category: News, Subrogation |
No Comments »
Tags:
Adam V. Russo | October 6, 2010
Lawsuit by an ERISA plan sponsor challenging New York’s anti-subrogation statute.
Click the link below to see the Court’s September 13th decision:
http://www.erisaboard.com/forum/attachment.php?attachmentid=1534&d=1284573407
Category: New York, Subrogation |
No Comments »
Tags:
Adam V. Russo | September 16, 2010
NASP, www.subrogation.org
NASP was invited to speak to the Ohio State Bar Association (OSBA) Subrogation Committee Meeting on September 14, 2010. NASP President Elect, Ken Levine, was in attendance and NASP Amicus Committee Chair, Daran Kiefer, represented NASP at this meeting, presenting written testimony that you can read on the NASP website at www.subrogation.org. (more…)
Category: Ohio, Subrogation |
No Comments »
Tags:
Adam V. Russo | September 7, 2010
Summary
State appeals court in Missouri affirms trial court ruling — Scroggins was injured in a trip-and-fall at a R.Lobster. Her employer’s (St. John’s Hospital, a subsidiary of Sisters of Mercy) self-funded plan covered her health expenses. Also, she sued the restaurant and extracted a settlement. The plan had subro clause up to the full amount it paid in expenses. The trial court refused to enforce the lien (it was a veiled partial assignment of her personal injury claim, and contrary to Missouri public policy). The plan was not subject to ERISA, because of its religious non-profit affiliation made it a church plan. Accordingly, the appeals court upholds state public policy, noting (a) that tort settlement is for pain and suffering, which is not to be a marketable commodity; (2) the plan had no separate claim against the tortfeasor; cases where liens were allowed in personal injury claims involved payers that claims against tortfeasor.
Click here to see the entire case
Category: 8th, Missouri, Subrogation, Welfare Benefit Plans |
No Comments »
Tags:
Adam V. Russo | 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” and “common fund” rules. States have an interest in: (1) keeping the cost of auto liability insurance low; (2) ensuring that wrongdoers pay full damages; and (3) making sure attorneys are paid for representing clients. These are at odds with the federal government’s goal of keeping the cost of health coverage reasonable. It remains to be seen if the federal government will try to resolve this through preemption of state laws beyond self-funded ERISA plans.
Category: Attorneys' Fees, ERISA, Made Whole Rule, Preemption, Subrogation |
No Comments »
Tags:
Adam V. Russo | 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 time is needed to develop regulations dealing with the vast scope and complexity of those problems, and because of the need to phase in increased costs that reform will cause in its early years. That means we really won’t know whether or not the law will achieve either goal, or even if it will survive the current complex political situation. (more…)
Category: ERISA, Health Care Legislation, Made Whole Rule, Preemption, Subrogation |
No Comments »
Tags:
Adam V. Russo | 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 can be cases where the amount of the tort settlement seems to include significant amounts to reimburse losses beyond actual medical expenses incurred by the plan participant and paid by the ERISA plan. In this case, the 11th Circuit upheld an earlier ruling allowing the plan to recover the full amount it paid to a participant who received a much larger settlement. The decision was unusual in the clarity of its explanation of why the subrogation was in fact equitable. The plan gained an advantage by becoming involved in the tort settlement early enough to ensure a separate and identifiable portion of the settlement was set aside. (more…)
Category: 11th, ERISA, Made Whole Rule, Stop Loss, Subrogation, Summary Plan Description |
No Comments »
Tags:
Adam V. Russo | 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 often rely on state statutes, but they often raise other issues. A recent decision by a U.S. District Court in Georgia in favor of the plan’s right to reimbursement indicates how modern federal courts dispose of those arguments. The case is Brown & Williamson Tobacco Corp. v. Collier, 2010 WL 1487772 (M.D. Ga., April 13, 2010). (more…)
Category: ERISA, Georgia, Made Whole Rule, Subrogation, Summary Plan Description |
No Comments »
Tags:
Adam V. Russo | 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 tort settlement proceeds. (more…)
Category: ERISA, Michigan, Subrogation |
No Comments »
Tags:
Adam V. Russo | 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 page 11 of this Newsletter, the objectives of ERISA sometimes conflict with the objectives of state laws. (more…)
Category: ERISA, New Jersey, Preemption, Subrogation, Supreme Court, Welfare Benefit Plans |
No Comments »
Tags:
Adam V. Russo | 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 rather than on lower rates negotiated by that person’s medical insurer. The case is People v. Scott, 2010 WL 1820181 (Cal. App., 4 Dist., May 7, 2010). (more…)
Category: California, Subrogation |
No Comments »
Tags:
