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FEHBP Plans Not Subject to State Laws Coventry Health Care of Missouri, Inc. v. Nevils April 18, 2017 S. Sup. Ct. 16–149 The U.S. Supreme Court ruled yesterday that Contractual subrogation and reimbursement rights of federal employees’ private health insurance carriers override state laws barring subrogation and reimbursement (Ginsburg, J.) In a unanimous decision, the […]

Pa highest court clarifies road map for Workers Comp  carriers to protect Subrogation claims.   The Honorable Judge Olson has clarified the “Magic words “ by which a  Workers Comp Carrier in Pennsylvania can assert a Subrogation claim against a Third Party pursuant to the much litigated Section 319 of the Pa Workers Comp Act.  […]

New York Court of Appeals Upholds No-Fault Rule Denying Health Insurer Reimbursement and Equitable Subrogation Rights Members Left in the Middle   In a well-reasoned yet anti-consumer opinion, the NY Court of Appeals in the matter of Aetna v. Hanover has reconfirmed a position taken by the NYS Insurance Department since 2008 that health insurers […]

The U.S. Supreme court today in the case of  Montanile v. National Elevator  ruled that ERISA health Benefit Plans are limited under the laws of Equity to recover only those specific traceable funds available from a settlement .   In the case of Montanile, the Defendant settled his personal injury case for $500,000 arising from an […]

The United States Office of Personnel Management (OPM) has just issued a final rule to amend the Federal Employees Health Benefits (FEHB) Program regulations to reaffirm the exempt nature of the FEHBP plan as not subject to State laws. (see OPM FEHPB conditional payment regs).  5 U.S.C. 8902(m)(1), provides: “The terms of any contract under this […]