Insurance Defense Quarterly Newsletter – January 2015
In John Doe v. Archdiocese of Milwaukee, No. 13-3783 (2014), “John Doe” settled his sexual abuse claims against the Archdiocese after participating in voluntary mediation. Doe signed a settlement agreement containing a confidentiality clause, another clause providing that the parties could not introduce as evidence in later proceedings matters including views expressed or admissions made during the mediation proceedings, and a provision stating that the settlement was entered into “to otherwise resolve and settle all disputes between them.” After the Diocese filed for bankruptcy relief, Doe filed a proof of claim. The Archdiocese objected to Doe’s proof of claim on the basis that he participated in mediation and executed a settlement agreement with a complete release and moved for summary judgment.
In Schaefer v. Taylor and Amica Mutual Ins. Co., 2013AP2419 (2014), originating in Dane County, Wisconsin, the plaintiff was injured when the defendant struck her while snowboarding. The defendant was 21 and a full-time student. The defendant’s parents held a homeowner’s policy issued by Amica. The defendant argued that because he was in school full-time, he was an “insured” pursuant to the terms of the Amica policy.
While Matthiesen, Wickert & Lehrer, S.C. (MWL) attorneys are actively pursuing subrogation and reimbursement claims around the country for health insurers and plans alike, we are increasingly being asked to defend clients from out-of-network lawsuits by providers. Recently, MWL attorneys, Ryan Woody and Emil Ovbiagele, successfully defended a health plan that was sued in Colorado for failure to fully pay an out-of-network provider’s charges. Defending these claims can be a lot more difficult as a court may decide that the ERISA preemption may or may not apply. Health plans and TPAs for these plans can expect to see a rise of these types of cases. Thus, they must be proactive and have a formidable plan for defending these claims.
Ryan Woody will be presenting a free webinar on Medicare Advantage Update: Enforcing Your Rights Under The Medicare Secondary Payer Act on February 24, 2015 from 10:00-11:00 a.m. (CST). This webinar will discuss several recent decisions involving the rights of Medicare Advantage Organizations (MAOs) and their enforcement rights under the Medicare Secondary Payer Act. It will also focus on MAO’s rights against both primary plans and the enrollee and provide practical guidance for steering your MAO case through litigation to a successful resolution. Don’t miss this hot topic! For more information on this webinar and/or to register for it, click HERE.