Healthplanlaw.com

A Practical Guide to ERISA and Group Benefit Plans

WebIn any action brought by a plan participant, beneficiary, or fiduciary under ERISA, “the court in its discretion may allow a reasonable attorney’s fee and costs of action to either party.” …

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URL: https://healthplanlaw.com/

Court Remands Insurer's Recoupment Claims Against Provider to …

WebRecoupment litigation against health care providers remains a controversial area in ERISA jurisprudence. The boundaries for plan claims against beneficiaries in …

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Provider Claims Barred By Insurer’s Anti-Assignment Clause

WebSince only a fiduciary, participant or beneficiary may assert an ERISA claim for benefits, a health care provider must obtain a valid assignment to pursue a claim …

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An Employer’s Guide to Group Health Continuation Coverage …

Web1The original health continuation provisions were contained in Title X of COBRA, which was signed into law (Pub. L. No. 99-272) on April 7, 1986. 2The COBRA provisions of the …

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:: ERISA’s Plan’s Reimbursement Claim

WebThis is a very significant opinion addressing ERISA health plan subrogation. I uploaded the opinion on erisaboard.com and this is a cross-post of the commentary on …

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:: Seventh Circuit Permits Provider To Assert State Law Claims Over

WebFranciscan Skemp Health care v. Central States, No. 07-3456 (7th Cir.) (July 31, 2008) In this recent provider reimbursement case, the Seventh Circuit has given …

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:: The Myth Of the “Partially Self-Insured” Group Health Plan

WebProctor Hosp., 517 F.3d 944 (C.A.7 (Ill.) (February 27, 2008) Group health plans are self-funded or they are insured. That employers or plans purchase stop loss …

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Power of Attorney May Supply Standing for Health Care Providers …

WebThis is an important decision for health care providers who encounter patients whose insurance coverage is out of network for their practice. The court referred …

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:: New Scholarship Addresses Retiree Medical Benefits Issues

WebA new article published by Richard L. Kaplan, Nicholas J. Powers and Jordan Zucker in the Yale Journal of Health Policy, Law, and Ethics addresses the issues …

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Claims Appeals – The New Order Of Affairs For ERISA Plans (Part II)

WebThe interim final regulations (Interim Final Rules for Group Health Plans and Health Insurance Issuers Relating to Internal Claims and Appeals and External Review …

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:: Health Care Providers’ RICO Claims “Reversed Preempted”

WebThis recent unpublished Sixth Circuit opinion applies reverse preemption to defeat the RICO claims of out of network health care providers. The health care …

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:: Sixth Circuit Opinions Applying Estoppel In ERISA Cases – An

WebTrustees of the Mich. Labors’ Health Care Fund v. Gibbons, 209 F.3d 587, 591 (6th Cir. 2007). Smiljanich v. GMC 2008 U.S. App. LEXIS 24605 (December 5, …

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Eighth Circuit Holds Mental Health Treatment Limitation Inapplicable

WebWhile there is certainly evidence that mental health treatment was one focus of S.W.’s hospitalization, we conclude there is insufficient evidence to support the …

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:: Workers’ Compensation Settlements Vulnerable To Recoupment

WebTackett, 2008 WL 2020504 (S.D.Ill.) (May 09, 2008) In a very well-reasoned opinion, the district court in Tackett held that workers’ compensation awards are subject …

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:: PHCS Rate Schedule Challenged In New Managed Care Litigation

WebHumana (S.D. Tex.) challenges Humana’s alleged use of the “Prevailing Healthcare Charges System” to establish rates of reimbursement for out of network …

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:: EBSA Cites Statistics Showing Effective

WebIn FY 2009, EBSA closed 3,669 civil investigations, with 2,833 (77.21%) resulting in monetary results for plans or other corrective action. “Civil Investigation Statistics …

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:: Common Fund Doctrine Applied In ERISA Subrogation Case …

WebSheet Metal Workers Local 27 Health & Welfare Fund, 2008 U.S. Dist. LEXIS 99345 (December 9, 2008) Here is a recent district court opinion out of the Third Circuit …

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:: Sixth Circuit Applies Trilogy Of Supreme Court ERISA Cases In

WebThe effect of the prevailing wage statute on ERISA-covered apprenticeship programs in California is substantially similar to the effect of New York law on ERISA …

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:: ERISA Plan Subrogation Provisions Eliminate Attorneys’ Fee Claim

WebThe defendant and his lawyer argued that attorneys’ fees and costs incurred in obtaining the settlement — amounting to $14,467.44 — must be deducted from the …

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Appropriate” Equitable Relief Under ERISA Section 502(a)(3) – …

WebOn 22 February 2005, the personal injury plaintiff, O’Hara, was seriously injured in a head-on collisions. The ERISA-governed group health plan providing his …

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:: Health Net Settlement At $215 Million May Set Class Action Record

WebHealth Net Inc. has agreed to pay $215 million and make $40 million worth of improvements in its business practices to settle three class action lawsuits that alleged …

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:: Compliance With External Review Requirements

WebThe new group health plan external review requirements require analysis on several levels. Some of the more obvious issues involve whether the external review …

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