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Health Alert (Australia) - February 22, 2016

IN THIS ISSUE: In This Issue: - Judgments; Legislation; and Reports. - Excerpts from Judgments: Queensland 12 February 2016 - Gobus v State of Queensland (Cairns and Hinterland Hospital and...more

Health Alert (Australia) - January 25, 2016

In This Issue: -Judgments; Legislation; and Reports -Excerpt from Judgments Commonwealth. Fair Work Commission 15 January 2016 - Lawrence v Calvary Home Care Services Ltd [2016] FWC 175 This...more

The Supreme Court Narrowly Defines an ERISA Plan’s Right to Subrogation in Montanile v. Board of Trustees of Nat. Elevator...

Most ERISA group health plans have subrogation terms – that is, terms allowing the plan to recover benefits paid to injured participants who later recover a tort settlement for their injuries. These subrogation claims are...more

Bad News for ERISA Plan Reimbursements: Chase The Money Before Settlement Funds Dissipate, Supreme Court Rules

This just in…. A big debate was resolved today by the United States Supreme Court: Can an ERISA plan sue to recover medical expenses paid on the participant’s behalf after the settlement funds have dissipated?...more

Supreme Court Decides Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan

On January 20, 2016, the U.S. Supreme Court decided Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, No. 14-723, holding that where an ERISA-plan participant has dissipated a third-party...more

Check--and Double Check--to Avoid Professional Liability in New Jersey

A recent New Jersey Supreme Court decision warns that health-care facilities that fail to do appropriate due diligence before granting privileges to physicians could face potential liability for that failure. In Jarrell v....more

Equitable in Name Only?: Tracing a Long and Tortured Path

Knowingly spending money that isn’t yours sounds like a no-no, but depending on how the Supreme Court rules in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan (No. 14-723), certain ERISA...more

Health Alert (Australia) - August 17, 2015

In This Issue: - Judgments; Legislation; and Reports. - Excerpt from Judgements: New South Wales (NSW) 13 August 2015 - Waller v James [2015] NSWCA 232 The NSW...more

Pennsylvania Court Dismisses Data Breach Claims

In 2014, the University of Pittsburgh Medical Center’s computer system was hacked, resulting in the disclosure of sensitive personal information of current and former employees, including names, addresses, birthdates, social...more

“Burt’s Law” Places New and Enhanced Responsibilities on Employees and Volunteers In Facilities Providing Care for Those with...

According to press reports across North Carolina, Burt Powell was a resident of a group home for adults with mental disabilities. His parents placed him in the facility to increase his chances of achieving a more independent...more

The Fraudulent Joinder Doctrine...It’s Not Just For Fraud Or Joinder

In Weidman v. ExxonMobil Corporation, et al., No. 13-2007 (4th Cir., January 8, 2015), the Fourth Circuit confirmed that the “fraudulent joinder” doctrine requires neither an allegation of fraud nor a situation involving a...more

Employee Benefits Developments - December 2014

Can a Medical Plan Enforce a Third-Party Recovery Provision Appearing Only in an SPD? Group health plans are often required to cover medical expenses associated with injuries caused by a third party’s negligence. These...more

Health Alert (Australia) - June 16, 2014

In This Issue: Judgments; Legislation; and Reports. - Except from Judgments: New South Wales - 12 June 2014 - Rosten v Mid North Coast Local Health District [2014] NSWIRComm 29 - This was...more

ERISA (7th Cir.): Beneficiary and Attorney Who Ignore Subrogation Lien for Medical Bills Paid by ERISA Plan “Better Call Saul”

You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA...more

Health Alert (Australia) - 17 February 2014

In This Issue: Judgments, Legislation, and Reports. Except from Reports: Australia. National Health & Medical Research Council (NHRMC) - 12 February 2014 - NHMRC - funded research among...more

Appellate Court Notes - Week of December 23

AC34963 - Compassionate Care, Inc. v. Travelers Indemnity Co. - The plaintiff was in the business of maintaining a list of nurses it referred out, as needed, to hospitals and nursing homes. It did background checks on...more

The Supreme Court Defers to Plan Language in U.S. Airways, Inc. v. McCutchen

Summary - In U.S. Airways, Inc. v. McCutchen, the US Supreme Court recently considered whether certain equitable defenses override the terms of a welfare plan in a plan fiduciary's suit for reimbursement under §...more

Express Plan Terms Allow Self-Insured Plan to Recover Medical Benefits Paid to Employee Post-McCutchen

In Quest Diagnostics v. Bomani, et al., 11-CV-00951 (D. Conn., June 19, 2013), the court granted Quest Diagnostic’s (“Quest”) motion for summary judgment, ruling that Quest, as the fiduciary to its self-insured medical plan,...more

Group Health Plan Can Enforce Reimbursement Rights Against Trustee

On the heels of the United States Supreme Court’s recent holding in U.S. Airways v. McCutchen, where the Court held that a group health plan’s reimbursement rights are not automatically subject to equitable defenses, it...more

High Court Holds Equitable Defenses Do Not Trump ERISA Plan’s Clear Reimbursement Language

The Supreme Court’s April decision in U.S. Airways, Inc. v. McCutchen resolves a circuit split on the issue of a medical plan’s right to reimbursement of medical expenses from a plan participant who recovers on a personal...more

Supreme Court Clarifies Subrogation Rights, Emphasizes Need for Precise Plan Language

Plan sponsors, particularly those that sponsor self-funded health plans, should review plan document provisions in light of the recent decision of the Supreme Court of the United States in US Airways, Inc. v. McCutchen. In...more

Supreme Court Upholds Health Plan’s Right To Recover Money from Third Party

The U.S. Supreme Court has ruled that the clear terms of an employer's group health plan override an employee's equitable defenses in determining the plan's right to recover amounts from a third party. This decision points...more

The U.S. Supreme Court Upholds Plan Sponsor’s Recovery Of Participant Damages Award

On April 16, 2013, the U.S. Supreme Court issued its opinion in U.S. Airways, Inc. v. McCutchen finding in favor of U.S. Airways in its quest to recover $66,866 in medical expenses incurred by its employee as a result of a...more

Illinois Jury Found Nursing Home Liable For $28.1 Million In Whistleblower Case Alleging Substandard Care And Resident Abuse

An Illinois district court jury in United States v. Momence Meadows Nursing Center, Inc. recently issued a verdict on February 11, 2013 imposing $28.1 million in civil penalties on the operators of a nursing home. The nursing...more

Creepy Crawly Bedbugs—What Do They Have to Do with OSHA?

With Halloween right around the corner, what better time to blog about creepy, crawly things that go bump in the night? Or at least just bedbugs....more

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