Everything listed under: subrogation

  • More Treatment Following Settlement of Claim

    Question: Can client’s health insurance demand additional subrogation for follow up treatment provided after client’s 3rd party claim was settled and disbursed? Are bills for such treatment considered unrelated?Answer: I don’t think you can eliminate the bills as unrelated if they are a follow-up to the treatment for the injuries incurred in the collision from which your claim arose. However, I think the subrogation claim ceased as to treatment incurred after you settled the cl...  Read More...

  • FEHBA Preemption and Common Fund Doctrine

    Question: Is there any federal common law that supports the “common fund” doctrine?Answer: I think you are getting ready to lose this one. I have read Helfrich and find it sobering. The problem I see is that the judge is going to be bound to follow Helfrich, because it is a 10th Circuit decision, binding on her/him as a District Judge in the Circuit.   Read More...

  • Oklahoma Make Whole Rule

    Question: Does Oklahoma’s “make whole” rule apply to a large subrogation demand from client’s Oklahoma insurer on an individually purchased health insurance plan?Answer: I think the direct answer is that the make whole rule will be applied except to the extent that the insurance plan has language negating the applicability of the make whole rule.Equity Fire and Cas. Co. v.   Read More...

  • Incurred vs. Paid

    I have a car wreck case with surgery bills paid by health insurance. Health insurance disclaims subrogation. Liability carrier claims that means I have no medical damages, citing “paid versus incurred” statute. Is that right.  Read More...

  • UM subrogation

    I've got a motor vehicle accident case where we obtained the tortfeasor's policy limits and the underinsured motorist ins. co.'s policy limits. Both policies were minimal. Client had health insurance, and a subrogated company is wanting reimbursement. I know they can seek reimbursement as to the tortfeasor's policy, but, can the health insurance subrogate against the UM?  Read More...

  • Federal Employee Health Benefit Act Subrogation

    Be aware that the U.S. Office of Personnel Management, which runs the Federal Employee health insurance program under the Federal Employee Health Benefit Act is trying to pull a fast one. That agency has posted on its website a letter.   Read More...

  • Interesting Bad Faith UM Issue

    Client is EMT in back of ambulance when hit by tortfeasor. After settling with the tortfeasor he finds out EMSA has UM that covers employees. UM now denies coverage saying that its subrogation was destroyed by the settlement and release. Client did not know of the employer’s coverage at time of settlement and release with tortfeasor. EMSA notified its carrier of the accident and of injury to an employee but the insurance did not notify the employee of the policy benefit. They have filed an MSJ and response due shortly.  Read More...

  • Healthcare Liens

    Do health care liens attach to medpay benefits? What aboutsubrogation claims by an ERISA plan?

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  • ERISA Plan and Recovery Costs for Subrogation

    There is an important new case out of the 3rd Circuit addressing whether ERISA health insurance plan must pay its share of recovery costs associated with its subrogation claim: US Airways, Inc. v. McCutchen, __F.3d __, 2011 WL 5557411: Where ERISA claim for bills paid was $66,866 and recovery (due to limited coverage) was $110,000 and injured plan member owed 40% attorney fee, District Court erred in requiring injured plan member to pay back all of the recovery.   Read More...

  • Health Insurance Subro

    Plaintiff injured in auto wreck has health insurance pay bills. She is later discharged in bankruptcy, listing the health insurance as a creditor. Does this extinguish their subrogation claim?  Read More...

  • Application of Med-Pay When Injured Party on the Job

    If both medpay and UM are available under the policy, you can claim them both  Read More....
  • Blue Cross Blue Shield Policy

    Do you have a Blue Cross Blue Shield policy so I can see the subrogation language?  Read More...
  • Health Insurance Subrogation

    Isn't it true a health insurance subrogation claim is null and void against a GTCA case?  Read More...