• Precision
• October 2nd, 2014

A decision handed down yesterday, September 30, 2014 by the United States District Court Central District of California in Mull v. Motion Picture Industry Health Plan, LA CV 12-06693-VBF.

The following analysis come to us from Professor Roger Baron:

Yesterday the U.S. District  Court for California, Central Division (Los Angeles) entered its ruling that the Motion Picture Industry ERISA plan's reimbursement provisions are enforceable because they are contained only in the plan's Summary Plan Description (SPD) and not in a Plan Document.  This situation which developed here was especially burdensome for the ERISA beneficiary and her family.  The ERISA plan had paid $148,000 of medical bills and then demanded the victim turn over her entire tort recovery of $100,000, plus interest.  When the victim refused, the ERISA plan quit providing health coverage for the victim and her entire family of four. 

• Precision
• August 13th, 2014

A recent decision handed down by the U.S. Court of Appeals for the Second Circuit court has overturned the Federal Court for the Eastern District of New York's opinion and affirmed the application of NY General Obligations Law §5-335 as a law that regulates insurance.

 Although §5-335 was recently amended to specifically apply to insurance, the Second Circuit confirms what we knew all along: insured ERISA plans do not get the benefit of federal preemption, and therefore §5-335 applies to negate any subrogation and/or reimbursement claims by insured plans.

Please take a moment to review Professor Roger Baron's comments on the decision, provided below.

• Precision
• March 18th, 2014

I have been keeping quiet with my fingers crossed for several months now, knowing that my friend and expert ERISA attorney, Tybe Ann Brett, Esq. had filed an application to serve an Amended Answer and Counterclaim in U.S. Airways v. McCutchen.  The Counterclaim alleges, among other things, Breach of Fiduciary Duty by the plan, and statutory violations for Failure to Disclose, after remand from the United States Supreme Court.

Today, nearly one year after the U.S. Supreme Court's unfavorable ruling, I am pleased to report that the United District Court for the Western District of Pennsylvania granted Mr. McCutchen's request, as seen in the Memorandum Decision available for download here.

• Precision
• December 31st, 2013

It's getting tougher out there.

On December 26, 2013, President Obama signed the Bipartisan Budget Act of 2013. Section 202 of the Act is entitled "Strengthening Medicaid Third-Party Liability." The new law amends portions of the federal Medicaid Act in an attempt to override the application of the allocation theory derived from Arkansas Dept. of Health & Human Srvs. v. Ahlborn, 547 U.S. 268 (2006). There are three main amendments to the statutes which take effect on October 1, 2014.

First, 42 U.S.C. § 1396a(a)(25)(H) has been amended, which now provides that "to the extent that payment has been made under the State plan for medical assistance in any case where a third party has a legal liability to make payment for such assistance * * * the State is considered to have acquired the rights of such individual to any payments by such third party."