ERISA and Health Insurance Subrogation In All 50 States
is the most complete and thorough treatise covering the complex
subject of ERISA and health insurance subrogation ever published.
NEW TO THE FIFTH EDITION!
• Updated To Include All The Newest Case Law!
• Updated To Include Medicaid Subrogation and Preemption of FEHBA !
• New Plan Language Recommendations!
• Complete Health Insurance Subrogation Laws In All 50 States
• Covers The Application of ERISA In Every Federal Circuit
The Fifth Edition of ERISA and Health Insurance Subrogation In All 50 States
has been completely revised, edited, and reorganized. This was partly
to reflect the new direction recent case decisions have taken
regarding health insurance subrogation as well as the crystallization of
formerly uncertain and nebulous areas of the law which have now
received some clarity. An entirely new chapter entitled, “What
Constitutes Other Appropriate Equitable Relief?” has been added and
replaces the old Chapter 9, which merely dealt with Knudson and
Sereboff. The new edition introduces new state court decisions
addressing the issue of causation and whether and when a subrogated Plan
seeking reimbursement must prove that the medical benefits it seeks to
recover were causally related to the original negligence of the
tortfeasor. An entirely new section was added concerning the subrogation
and reimbursement rights of Medicare Advantage Plans, a
statutorily-authorized Plan which provides the same benefits an
individual is entitled to recover under Medicare. This includes recent
case law which detrimentally affects the rights of such Plans to
subrogate. Also added to the new edition is additional law and
explanation regarding Medicaid subrogation, including the
differentiation between “cost avoidance” and “pay and chase” when it
comes to procedures for paying Medicaid claims. Significant improvements
have been made to suggested Plan language which maximizes a Plan’s
subrogation and reimbursement rights. The suggested language stems from
recent decisions and developments in ERISA and health insurance
subrogation from around the country since the last edition.
The new edition has been completely reworked both in substance and
organization. Recent case law has necessitated consolidation of several
portions of the book and elimination or editing of others. A new section
entitled “Liability of Plaintiff’s Counsel” has been added, which
provides a clearer exposition on the laws applicable and remedies
available when plaintiff’s attorneys and Plan beneficiaries settle their
third-party cases and fail to reimburse the Plan. Also new to the book
are recently-passed anti-subrogation measures such as Louisiana’s Senate
Bill 169, § 1881, which states that no health insurer shall seek
reimbursement from automobile Med Pay coverage without first obtaining
the written consent of the insured.
The new edition also goes into much greater detail on the procedures for
and law underlying the practice of removal of cases from state court to
federal court, and the possibility of remand back to state court. This
includes the Federal Courts Jurisdiction and Venue Clarification Act of
2011, effective Jan. 6, 2012, which amended federal removal, venue, and
citizenship determination statutes in very significant ways. The new
edition also delves into, for the first time, the role which the federal
Anti-Injunction Act plays when beneficiaries sue in state court to
enforce the terms of an ERISA Plan, while the Plan files suit in federal
court seeking an injunction against the state court action. New case
law and discussion on preemption of FEHBA subrogation and reimbursement
claims have been added to Chapter 10 in the wake of new decisions