Medical Expenses

News & Analysis as of

Supreme Court Limits ERISA Reimbursement Rights: Insurers Will Need to be Diligent

On January 20, 2016, the United States Supreme Court held that an ERISA plan could not satisfy its reimbursement rights from a participant’s general assets. ERISA plans’ reimbursement rights are now so limited that...more

The ERISA Litigation Newsletter - March 2016

Editor’s Overview - This month we review the U.S. Supreme Court’s decision in Montanile v. Board of Trustees of National Elevator Industries Health Benefit Plan where the Supreme Court considered the scope of...more

Supreme Court Limits Plan’s Ability to Recoup Medical Expense Payments

In Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, the US Supreme Court held that when an ERISA plan participant completely dissipates a settlement from a third party on items that are...more

Time to Review Plan Subrogation Procedures

Most self-funded ERISA medical plans provide that participants who have been injured by other people (think car accidents) must reimburse the plan if the participant recovers from the other person for those injuries. In order...more

Supreme Court Rules Employee Benefit Plan Out of Luck Once Settlement Funds Are Spent on Nontraceable Items

The U.S. Supreme Court in Montanile v. Bd. of Trs. of Nat. Elevator Indus. Health Benefit Plan, U.S., No. 14-723, 1/20/2016,considered what happens when a participant in an employee benefits plan under the Employee Retirement...more

Things to Remember at Tax Time

April 15th is approaching and it is time to begin crossing T's and dotting I's in preparation for paying taxes. As tax time draws near, you want to make sure you file all the proper forms and take all deductions you're...more

Obamacare in the Courtroom: In the Matter of Double Recovery

The Patient Protection and Affordable Care Act (ACA), a/k/a Obamacare, was drafted to make health care and health insurance more affordable and more available to more Americans as well as to relieve some of the burden on...more

Supreme Court requires fast action for ERISA subrogation recovery

A nearly unanimous Supreme Court recently found that a health plan cannot recover amounts subject to subrogation if the recipient has already spent the settlement funds....more

Montanile, Amgen, Tackett & Moen: Four Important Employee Benefits Cases to Kick Off 2016

The year 2016 has only just started, and we have already seen several important court decisions related to employee benefit plans and the Employee Retirement Income Security Act of 1974, as amended (ERISA). This Client Alert...more

Supreme Court Says No Subrogation Claims from Health Plan After Participant Spends Settlement

On January 20, the Supreme Court released its decision in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, concluding that although health plan fiduciaries can generally seek subrogation...more

Supreme Court Interprets ERISA to Limit Remedies Available to Plans to Subrogate and Recover Overpayments

Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan is the fourth decision by the U.S. Supreme Court addressing the subrogation rights of self-insured ERISA-covered health plans. Three...more

ERISA Plans Should Act To Reinforce Reimbursement Rights In Light Of Recent SCOTUS Decision

Group health plan administrators should take actions to address the recent U.S. Supreme Court decision holding that an ERISA plan cannot enforce its equitable lien, which had been established through the plan’s reimbursement...more

Supreme Court: For ERISA Plans, Time May Be Money

A new U.S. Supreme Court decision is a reminder that Employee Retirement Income Security Act (ERISA) plans must act promptly if they want to assert a lien to secure a participant’s obligation to reimburse medical expenses or...more

Supreme Court Sends ERISA Plans Racing to the Courthouse for Subrogation Recoveries

The Supreme Court of the United States recently handed down a decision that opens the door for participants in ERISA-covered benefits plans to stop a lawsuit against them in its tracks by doing something that most people love...more

Hurry up and Spend the Money?

It’s like a simple set of facts on a law school exam with an answer that defies logic. And, yet, Supreme Court precedent has brought us to this illogical conclusion. Facts: Participant agrees to reimburse the plan money it...more

Recent Supreme Court Decision Limits ERISA Plans’ Ability to Recover Benefits Paid to Injured Employees Who Later Receive...

It’s a common scenario when dealing with a benefit plan governed by the Employee Retirement Income Security Act of 1974 (ERISA): an employee participating in the plan is injured by a third-party, the plan pays covered medical...more

Supreme Court Issues Further Clarification on Equitable Relief Remedies Available Under ERISA

ERISA Section 502(a)(3) empowers plan fiduciaries to file suit “to obtain … appropriate equitable relief … to enforce … the terms of the plan.” In 1993, the Supreme Court of the United States interpreted this ERISA provision...more

Supreme Court Limits ERISA Healthcare Plan’s Reimbursement Rights: What Montanile Really Means

Last week, the United States Supreme Court held that an ERISA healthcare benefit plan with reimbursement rights can only obtain “appropriate equitable relief” when enforcing its lien against a third-party settlement, thus...more

Supreme Court: Health Plan Recovery Of Expenses Can Be Thwarted By Spendthrift Participant

In an 8-1 decision issued yesterday, the U.S. Supreme Court ruled that a health plan’s right of recovery against a plan participant who obtains an award from a third party found responsible for the participant’s injuries can...more

U.S. Supreme Court Limits ERISA Plan’s Subrogation Rights Where Participants Have Dissipated Funds Recovered from Third Parties –...

Over the years, the U.S. Supreme Court from time to time has explored the scope of equitable relief available under the Employee Retirement Income Security Act of 1974 (“ERISA”) in circumstances where an employee benefit plan...more

SCOTUS Rejects Plan’s Right to Dissipated Assets

The U.S. Supreme Court has ruled that an ERISA plan has no right to recover benefits paid on behalf of a participant where the participant has already dissipated settlement funds received from a third party. In...more

U.S. Supreme Court Decision in Montanile Applies Principles of Equity to Reach an Absurdly Inequitable Result Regarding ERISA Plan...

“A” gets hit by a drunk driver and incurs $121,044 in medical expenses. The ERISA Plan agrees to pay the expenses if “A” contractually agrees to reimburse the Plan for any recovery obtained as the result of any legal action...more

Supreme Court Provides More Guidance Regarding Health Plan Subrogation Claims

On January 20, 2016, the Supreme Court handed down yet another case addressing health plan subrogation. From the Supreme Court’s earlier decision in Sereboff v. Mid Atlantic Medical Services, Inc. (547 U.S. 356) (2006),...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

Supreme Court Rules No ERISA Plan Recovery of Nontraceable Settlement Funds

In Montanile v. Bd. of Trs. of the Nat'l Elevator Indus. Health Benefit Plan, the U.S. Supreme Court on January 19 held that when an ERISA plan participant wholly dissipates a third-party settlement on nontraceable items, a...more

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