Outsourcing of Lien Resolution – The Florida Supreme Court’s Ruling on 4-1.5
On April 12th, the Florida Supreme Court ruled on the proposed amendment to rule 4-1.5 and rejected it. What does this mean for lien resolution outsourcing?
CUTTING EDGE INDUSTRY THOUGHT LEADERSHIP INSIGHTS
Synergy’s blog brings you the industry’s foremost thought leadership InSights on matters of healthcare lien resolution and Medicare Secondary Payer Compliance. Visit often to discover helpful InSights on important lien resolution compliance issues.
Is your MSP compliance provider doing more harm than good by advocating to ignore Medicare’s future interests?
With Medicare Secondary Payer (“MSP”) Compliance on everyone’s minds these days, it is no wonder that MSP vendors have tried to capitalize on these fears by offering services targeting them. The problem is that some of these vendors may be doing more harm than good.
ERISA Beneficiary and His Wife Where Funds are in a Structured Settlement
Reprinted with Permission from Roger Baron
The 5th Circuit handed down ACS Recovery Services, Inc. v. Griffin today, April 2, 2012. Mr. Griffin was seriously injured in an auto accident. The ERISA plan paid medical bills of $50,076.19. The plaintiff’s attorney secured a settlement of $294,439.82 and arranged for a structured settlement annuity “in an effort to avoid any equitable lien assertion” by the ERISA Plan. Mrs. Griffin received $40,000 for loss of consortium. The ERISA plan sued Mr. Griffin and his wife, as well as the trustee and the trust designated to receive the annuity payments. The trial court “dismissed the claims against all of the defendants.” This decision by the 5th Circuit affirms that dismissal.
From Roger Baron: Revictimization of Personal Injury Victims By ERISA Subrogation
Reprinted with permission from Roger Baron
“Subrogation on personal injury claims by a health insurer was universally prohibited by law when Congress enacted ERISA in 1974. Seizing upon the notion of ERISA preemption, ERISA plans and related insurers have manufactured the right of reimbursement (or subrogation) without regard to the impact on the victims.”
US Airways v. McCutchen – Equitable Defenses Limit ERISA’s “Appropriate Equitable Relief”
Although most litigation has centered on what qualifies as “appropriate equitable relief,” the U.S. Court of Appeals for the Third Circuit in US Airways, Inc. v. McCutchen, 663 F.3d 671 (3d Cir. Pa. 2011), addressed whether such relief is limited by certain equitable defenses. While the Third Circuit’s approach may be considered novel (at least until adopted by other courts), it presently allows equitable principles to override express plan language when justified by the necessities of the particular case. For attorneys in other jurisdictions representing severely injured beneficiaries against self-funded ERISA liens with strong plan language, referencing the Third Circuit’s logic may prove beneficial.
Lien Resolution – The Contract Does NOT always Control
Ingenix v. Ham, a Florida 2nd DCA opinion, applies 768.76(4) instead of the contract in a reimbursement action involving UnitedHealthcare (non-ERISA).
Outsourcing Lien Resolution: Happier Clients and a Better Bottom Line
Outsourcing of lien resolution needs for a law firm can make for happier clients and a better bottom line.
Something Useful from MSPRC – “Self-Calculated Final Conditional Payment Amount” Option
The MSPRC announced a new option to self calculate a conditional payment amount to submit for approval if the settlement is $25,000 or less.
Requesting the Fixed Percentage Option from the MSPRC for Conditional Payments – A Quick How To
MSPRC has provided instructions on how to elect the fixed percentage option for conditional payment resolution.