Liens Health Insurance / Erisa

In US Airways, Inc. v. McCutchen, 2011 WL 5557411 (3rd Cir. Nov. 16, 2011), an ERISA plan sought reimbursement of 100% of what it had paid for medical bills for a car crash victim even though the victim had not been fully reimbursed because of limited liability coverage. The lawyers for the car crash victim claimed that the ERISA plan should reduce its claim pro rata for attorneys fees and costs. The ERISA plan administrators refused, and demanded reimbursement of 100% of what it had spent.

The ERISA plan eventually filed a lawsuit against the plan beneficiary seeking 100% reimbursement. The language of the plan states that the ERISA plan was entitled to reimbursement “for amounts paid for claims out of any monies recovered from a third party….”


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My client was severely injured in a motorcycle accident.  In a bad faith lawsuit against the at-fault driver’s insurance company we recovered a confidential amount well in excess of 150 times the policy limits.  My client’s health insurer paid around $200,000 for medical care related to the crash.

After resolving the bad faith case, my client’s health insurer asked my client to reimburse it the full $200,000 it spent on medical care.  I advised the recovery company for the health insurer that under Florida law, the health insurer was only entitled to a small fraction of what it was seeking.  They refused to budge and demanded payment of the full amount.


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My client was injured at work.  Her employer totally controverted the claim.  Because the claim was denied, she sought medical care under her employer sponsored HMO policy.

Eventually, she and her workers compensation lawyer settled the work comp case as a totally controverted claim.  The HMO sought reimbursement of its alleged lien out of the work comp settlement.  Her work comp lawyer asked the carrier to waive its lien, and the HMO carrier refused.


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My client was injured in an automobile accident.  My client was an HMO member through his employer.  The HMO was issued by Blue Cross and Blue Shield of Florida.  After the accident, Blue Cross and Blue Shield provided some medical services to my client that were accident related, and also provided some services that were not related to the accident. 


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On January 10, I wrote about a case which I filed in order to eliminate an ERISA health benefits lien that was being asserted against my client’s personal injury and uninsured motorists settlement.  The client’s personal injury attorney had made a good recovery for the client, but the ERISA plan wanted to be reimbursed 100% of

I filed suit today in federal Court against a self-funded ERISA plan which was seeking recovery of a lien against my client’s personal injury recovery.  My client was seriously injured in an automobile accident.  The self-funded ERISA plan paid for his medical treatment.  Unfortunately, there was limited bodily injury and uninsured motorists limits available.  My