Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.
Families and individuals injured by Vioxx may still have lien claims to resolve despite the Lien Resolution Administrator’s attempt to manage these claims. In a December 4, 2012 ruling the United States District Court, E.D. Louisiana denied the motion of approximately forty six (46) insurance companies to have their lien claims resolved from the Vioxx settlement fund.
Learn more about the Medicare recovery process under the MSP.
One of the keys to properly defending against an asserted subrogation or reimbursement claim from an ERISA plan is making requests to the plan administrator. One of the major responsibilities of the plan administrator, as to dealing with the providing of information to beneficiaries, is contained in 29 U.S.C. 1024(b)(4).
Reprinted with permission from Roger Baron
The 8th Circuit Court of Appeals handed down its decision in Treasurer, Trustees of Drury Industries v. Sean Goding, No. 11-2885. This is a situation where the ERISA plan doggedly pursued the law firm which had represented the ERISA beneficiary in securing a tort recovery.
The uncertainty that exists regarding a self-funded ERISA plan’s ability to refuse reduction of their claim based upon equitable principles can be used to increase your client’s net recovery. A gray area was created in ERSIA healthcare subrogation and reimbursement rights by the 11th Circuit’s April 2010 ruling in Zurich American Insurance Co. v. O’Hara.
In Ayers v. LINA, No. 6:08-cv-06287-AA, (D.Or. April 19, 2012), the court was adjudicating a dispute over LTD benefits under ERISA coverage. The court held “LINA cannot recover any overpaid amounts pursuant to 1132(a)(3) if Ayers can demonstrate that it was acting with unclean hands.” As to whether or not “unclean hands” exists, the court holds that there is a “genuine issue of material fact,” overruling both parties’ motions for summary judgment on the counterclaim.
On April 12th, the Florida Supreme Court ruled on the proposed amendment to rule 4-1.5 and rejected it. What does this mean for lien resolution outsourcing?
Reprinted with Permission from Roger Baron
The 5th Circuit handed down ACS Recovery Services, Inc. v. Griffin today, April 2, 2012. Mr. Griffin was seriously injured in an auto accident. The ERISA plan paid medical bills of $50,076.19. The plaintiff’s attorney secured a settlement of $294,439.82 and arranged for a structured settlement annuity “in an effort to avoid any equitable lien assertion” by the ERISA Plan. Mrs. Griffin received $40,000 for loss of consortium. The ERISA plan sued Mr. Griffin and his wife, as well as the trustee and the trust designated to receive the annuity payments. The trial court “dismissed the claims against all of the defendants.” This decision by the 5th Circuit affirms that dismissal.
Reprinted with permission from Roger Baron
“Subrogation on personal injury claims by a health insurer was universally prohibited by law when Congress enacted ERISA in 1974. Seizing upon the notion of ERISA preemption, ERISA plans and related insurers have manufactured the right of reimbursement (or subrogation) without regard to the impact on the victims.”