The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third party.
The case is US Airways v. McCutchen, U.S. Supreme Court, No. 11-1285.
http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf
This decision helps resolve a conflict…
The claimant seeking long term disability benefits under your ERISA Plan was found to be disabled by the Social Security Administration.
Does that automatically mean the claimant is entitled to disability benefits under the ERISA Plan? No, but you must explain why you are taking a position different from the Social Security Administration. Met …
What does “full and fair” review during an ERISA appeal mean?
Before the appeal decision is made, does the administrator have to disclose to the claimant medical opinions obtained during an appeal? Not if that opinion merely reaffirms or supplements the basis for the initial claim denial.
Here’s the recent case of Lee v. Hartford…
