Health Plan Law

Recent Posts from Health Plan Law

• :: Senate Health Care Bill Vote Emerges As Bellwether For Direction Of Reform

  Facts are stubborn, but statistics are more pliable. Quote by Mark Twain. The Senate’s prior versions of health care legislation are now merged in a bill which will face the threat of filibuster when presented…

• :: Clinical Evidence Protocols Rejected Under ERISA Plan’s Medical Necessity Standard

  While a plan administrator need not “accord special weight to the opinions of a claimant’s physician,” it also “may not arbitrarily refuse to credit a claimant’s reliable evidence, including the opinions of a treating physician.”Black…

• :: Sixth Circuit Holds Plaintiff’s Attorney Liable To ERISA Plan For Disbursed Settlement Funds

  Longaberger’s equitable lien attached to the settlement fund when it was identified and received in July 2004. Indeed, Kolt conceded at the district court’s February 9, 2005, hearing that he “probably” was aware at the…

• :: Enforcement Of Equitable Liens By ERISA Benefit Plans - A Contrast In Available Remedies

  In this case, Ms. Powell did not commingle her funds and made no purchases that diminished in value. Thus, the “conscious wrongdoer” standard has no application. Moreover, in Sereboff the Supreme Court stated, “This rule…

• :: H.R. 3962 Passes By Narrow Vote

  H.R. 3962, the House health care bill, passed by a vote of 220 - 215.  Changes to the original bill were required to obtain the necessary votes. Highlights of some of the changes are highlighted…

• :: Fact Check #4: “Endorsements” Of Health Care Legislation Are Deceiving

  It’s an open secret in Washington that only about 15-20 percent of doctors are members of the AMA.  Sermo, a 110,000-member, non-partisan online community of doctors — 25 percent of whom say they are members…

• :: Defensive ERISA Preemption Inadequate To Sustain Removal Of Subrogation Dispute

  Following an automobile accident, Plaintiffs Richard and Pamela Cottrill filed suit in the Court of Common Pleas of Perry County against Allstate Insurance Company (”Allstate”) and Blue Cross Blue Shield of Michigan (”Blue Cross”). In…

• :: A Primer On Venue Choice In ERISA Claim Disputes

  Plaintiffs originally filed their complaint in the Court of Common  Pleas of Philadelphia County, Pennsylvania. Defendants then removed the action to federal court. The plaintiffs’ choice of venue is generally accorded great weight, but other…

• :: Seventh Circuit Holds Disability Benefits Claim Incompatible With ADA Claims

  Claiming disability benefits and asserting ADA claims are not always mutually exclusive, but a “plaintiff’s sworn assertion in an application for disability benefits that she is, for example, ‘unable to work’ will appear to negate…

• :: Plan Language Sufficient To Authorize Settlement Of ERISA Benefit Claims With TCA’s

  Thus, the fact that the Kodak and GM Plans provided for distribution of death benefits through the establishment of a TCA, and that MetLife complied with those provisions, does not in itself immunize MetLife from…