Category Archives: ERISA and Health Insurance

ERISA and Health Insurance Subrogation Posts

Insurance Commissioner Overstepped Authority In Applying Made Whole Doctrine To Health Insurance Subrogation

Bayham v. State of Louisiana, Through the Office of Group Benefits, 2019 WL 4073410 (La. App. 2019). In a line from the History Channel’s television series Vikings, Viking chieftain Ragnar Lothbrok looks down at the village of Kattegat with his son … Learn More

Medical Billing, Insurance Write-Offs, And The Collateral Source Rule

Recovery of Medical Expenses in Personal Injury Actions Generally To recover damages for past medical expenses in a personal injury lawsuit, a plaintiff must present evidence and prove that the medical expenses incurred were both “reasonable” and “necessary.” For more than … Learn More

Xarelto Subrogation Shows Promise With Plaintiffs’ 1st Trial Win

A Philadelphia jury handed down a roughly $28 million verdict against Johnson & Johnson and Bayer AG on Tuesday, December 5, giving hope to tens of thousands of Xarelto plaintiffs after a series of defense verdicts in the federal multidistrict litigation … Learn More

BREAKING: Opioid Cases Consolidated Into MDL

After considering a motion brought by the plaintiffs in 46 actions pending in nine federal districts across the country, the Judicial Panel on Multidistrict Litigation (MDL) entered an order on Tuesday, transferring those actions to the Northern District of Ohio for … Learn More

THIRD TIME’S A CHARM: Missouri Supreme Court Finally Gets FEHBA Preemption Right

Some states, including Missouri, are known as “anti-subrogation” states. Missouri’s public policy prohibits the assignment of a personal injury claim, whether it is called an assignment, subrogation interest, or agreement to reimburse. Hays v. Missouri Highways and Transp. Comm’n, 62 … Learn More

2nd Circuit Weakens ERISA Preemption

A recent 2nd Circuit Court of Appeals decision interpreted New York’s General Obligations Law § 5-335, which provides that personal injury settlements “shall be conclusively presumed” not to include “any compensation for the cost of health care services, loss of … Learn More

Supreme Court Upholds FEHBA Subrogation Rights Over State Law

In a highly anticipated decision, the U.S. Supreme Court has finally weighed in on the issue of FEHBA subrogation and federal preemption of state laws in Coventry Health Care of Missouri, Inc. v. Nevils, 137 S.Ct. 1190 (April 18, 2017) … Learn More

New Major Medicare Advantage Decision

On August 8, 2016, the 11th Circuit issued its opinion in Humana v. Western Heritage, 15-11436 (11th Cir., August 8, 2016). It is a major victory for Medicare Advantage Organizations (MOAs) and a major blow to liability insurers. Matthiesen, Wickert … Learn More

Anti-Subrogation States Split On Impact Of Latest FEHBA Preemption Regulations

For over a decade, state and federal courts throughout the nation have wrestled with the issue of whether FEHBA (Federal Employees Health Benefit Act of 1959) preempts state subrogation laws. 5 U.S.C. §§ 8901-8914. Both Missouri and Arizona are well-known … Learn More

Oklahoma Option Flagged As Unconstitutional

In the 1970s, the Oklahoma Sooners’ NCAA football team successfully began implementing a new offensive system known as the “option offense.” Sooner Coach Barry Switzer has been credited by many for having perfected the use of the wishbone offense, a … Learn More