CUTTING EDGE INDUSTRY THOUGHT LEADERSHIP INSIGHTS

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ERISA Beneficiary and His Wife Where Funds are in a Structured Settlement

ERISA Beneficiary and His Wife Where Funds are in a Structured Settlement

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.

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US Airways v. McCutchen – Equitable Defenses Limit ERISA’s “Appropriate Equitable Relief”

US Airways v. McCutchen – Equitable Defenses Limit ERISA’s “Appropriate Equitable Relief”

Although most litigation has centered on what qualifies as “appropriate equitable relief,”  the U.S. Court of Appeals for the Third Circuit in US Airways, Inc. v. McCutchen, 663 F.3d 671 (3d Cir. Pa. 2011), addressed whether such relief is limited by certain equitable defenses. While the Third Circuit’s approach may be considered novel (at least until adopted by other courts), it presently allows equitable principles to override express plan language when justified by the necessities of the particular case. For attorneys in other jurisdictions representing severely injured beneficiaries against self-funded ERISA liens with strong plan language, referencing the Third Circuit’s logic may prove beneficial.

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CMS HQ Issues 1st Memo Regarding Liability Medicare Set Asides

CMS HQ Issues 1st Memo Regarding Liability Medicare Set Asides

On 9/29/11, CMS issued a memorandum indicating there is no need for a liability Medicare set aside and that its interests would be satisfied if the treating physician certifies in writing that treatment for the alleged injury related to the liability insurance has been completed as of the date of settlement.

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