News & Analysis as of

Medical Expenses Employee Retirement Income Security Act (ERISA)

Proskauer - Employee Benefits & Executive...

Sixth Circuit Highlights Importance of the Plan Document

A recent decision by the U.S. Court of Appeals for the Sixth Circuit (Patterson v. United HealthCare Ins. Co., No. 22-3167, 2023 WL 4882436 (6th Cir. Aug. 1, 2023)) illustrates the importance of clearly describing key plan...more

Hinshaw & Culbertson - The LHD/ERISA Advisor

ERISA Plan Entitled to Seek Reimbursement from Plan Beneficiary Who Recovered Damages in Tort Action Related to Underlying...

In Vercellino v. Optum Insight, 2020 U.S. Dist. LEXIS 205952 (D. Neb. Nov. 24, 2020), the Nebraska district court held that a self-funded ERISA plan could seek reimbursement for medical benefits paid from any recovery the...more

Jackson Lewis P.C.

Washington Steps Up Insurance Protections For Gender Affirming Treatments

Jackson Lewis P.C. on

As some states make headlines for so-called “anti-trans” laws, the Washington state legislature rejected a bill designed to limit youth participation in sports based on their gender as assigned on a birth certificate and...more

Seyfarth Shaw LLP

New Surprise Billing Legislation and Rules Go Into Effect on January 1

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New legislation passed in the 2019 session of the Texas Legislature, SB 1264, went into effect on January 1, 2020. The statute protects Texas residents from so-called surprise billing, where patients receive costly medical...more

Proskauer - Employee Benefits & Executive...

Ninth Circuit Enforces Hawaii Anti-Reimbursement Statutes Against Insured Plan

ERISA health care plans typically include reimbursement and subrogation clauses, which give plans a right to reimbursement of medical expenses paid on behalf of a beneficiary where the injury is caused by a third party. While...more

ArentFox Schiff

Third Circuit Upholds Anti-Assignment Provision Barring Provider’s ERISA Suit Against Insurer

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The US Court of Appeals for the Third Circuit recently confirmed that “anti-assignment” provisions — provisions prohibiting insureds from assigning their rights under a health plan to third parties, including medical...more

Troutman Pepper

Bipartisan Senate Group Pushes Bill to Protect Patients from Surprise Medical Bills

Troutman Pepper on

In September 2018, we wrote about a draft U.S. Senate bill aimed to protect patients from surprise medical bills, the “Protecting Patients from Surprise Medical Bills Act.” ...more

Mintz - Employment Viewpoints

Avoiding Unexpected Liability for Former Employees’ Medical Expenses

Adherence to the COBRA health care continuation rules is not always high on an employer’s list of priorities. Compliance is often “outsourced,” and even when handled “in-house,” it rarely consumes much attention. A recent...more

Seyfarth Shaw LLP

Be Careful Of Comments On Healthcare Costs: Sixth Circuit Denies Summary Judgment On ERISA Interference And Retaliation Claims...

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Seyfarth Synopsis:   An employer, which had paid medical expenses on behalf of an employee’s dependent son, made comments about the company’s rising healthcare costs several months before firing the employee. The Sixth...more

Michigan Auto Law

No-Fault vs. health insurance: What’s the better choice for crash victims?

Michigan Auto Law on

Health insurance is full of landmines for unsuspecting car crash victims, who are subject to ‘auto exclusions,’ coverage limitations, managed care, HMOs and medical pre-approval requirements and ERISA liens....more

Bradley Arant Boult Cummings LLP

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

Proskauer Rose LLP

The ERISA Litigation Newsletter - March 2016

Proskauer Rose LLP on

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

Morgan Lewis

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

Morgan Lewis on

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

Stinson - Benefits Notes Blog

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

Pillsbury Winthrop Shaw Pittman LLP

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

Parker Poe Adams & Bernstein LLP

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

Saul Ewing LLP

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

Saul Ewing LLP on

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

Brownstein Hyatt Farber Schreck

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

Eversheds Sutherland (US) LLP

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

Cozen O'Connor

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

Cozen O'Connor on

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

Bryan Cave Leighton Paisner

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

K&L Gates LLP

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

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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

McDermott Will & Emery

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

McDermott Will & Emery on

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

McGuireWoods LLP

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

McGuireWoods LLP on

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

Dechert LLP

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

Dechert LLP on

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

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