:: A Health Plan Subrogation Reader
For a quick, “hit the ground running” approach to health plan subrogation, you will find the following reading list useful:
Sereboff v. Mid-Atlantic [see discussion here ]
Wirth v. Aetna U.S. Healthcare, 2006 WL 3360457 (C.A.3 (Pa.)) (November 21, 2006).
Providence Health System-Washington v. Bush, 2006 WL 3249199 (W.D.Wash.) (November 8, 2006) [see discussion here]
The United Distributors Inc. Employee Health Benefit Plan, The Commerce Group, Third Party Administrator of the United Distributors Inc. Employee Health Benefit Plan, v. Deborah Parrott, Blue Cross Blue Shield of South Carolina v. Josue Carillo, Vincente Carillo[see discussion on this site here]
Moore v. Capital Care, Inc. 461 F.3d 1 (C.A.D.C.2006) [see discussion on this site here]
Subrogation Tips From Case Analysis [here]
Essential Requirements For Subrogation Provisions [here]
Health Plan Subrogation Provision Specimen Language [here]
Distinguishing Self Funded ERISA Plans From ERISA Exempt Plans [review :: How To Identify A Self-Funded ERISA Plan and :: How To Identify An Exempt Governmental Plan]
An important aspect of health plan subrogation which has not been addressed yet on this site is a list of common subrogation errors. Until that article is posted, note one of the most common pitfalls – ERISA plan liability cannot be bifurcated between stop loss insurance and the health plan. [See article here ]
If the plan is a self-funded ERISA plan, the plan is completely responsible for claims of plan participants. The stop loss carrier has no privity of contract with plan participants and pays no direct medical claims. (The stop loss contract will make this clear as the carrier has no intention of being liable for direct payment of claims.)
Therefore, in the subrogation context, the plan has sole and complete responsibility to undertake all subrogation efforts. Direct participation by the stop loss carrier or its agents in the subrogation process contradicts the basic assumption of ERISA plan operation and the preemption of State law.
For additional information on specific subrogation department training modules, send your inquiries to rharmon@healthplanlaw.com.
