SIIA Amicus Participation Contributes to Positive Judicial Outcome

April 17, 2013 — The United States Supreme Court yesterday handed down a unanimous ruling in the case of U.S. Airways, Inc. v. McCutchen that is widely viewed as a major win for employers who sponsor self-insured group health plans. The Self-Insurance Institute of America, Inc.
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AMICUS UPDATE

In a victory for healthcare subrogation, the United States Supreme Court reversed the Third Circuit’s holding in US Airways, Inc. v. McCutchen.  In stunning fashion, the Justices of the Supreme Court ruled 9-0 that equitable principles (such as the made whole and common fund doctrines
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A Victory for Subrogation… and a Focus on Plan Language

Today, April 16, 2013, the U.S. Supreme Court released its decision regarding the matter of US Airways, Inc. v. McCutchen Et Al., 569 U. S. ____ (2013), No. 11–1285.  For those of us whose lives are dedicated to the viability of health benefit plans, this decision represents both a gr
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TEXAS HOUSE BILL 1869 AND SENATE BILL 1339

Texas House Bill 1869 and the companion bill, SB 1339 in the Senate, are being rushed through committees. One of our members has personally met with representatives in both the House and the Senate, but these bills appear to be gliding through committees without opposition. These bill
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Anti-Subrogation Bill Emerges in Texas

Texas House Bill 1869 seeks to limit health subrogation recoveries! The bill allows a carrier to create the right to subrogation or the right to reimbursement by contract. However, the bill restricts the amount a carrier may recover to the lesser of the following: a. one third of the
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Equitable Defense Rejected In Health Plan Reimbursement Litigation

Schwade’s ERISA health benefits plan (”the Plan”) declined to pay medical expenses for Schwade’s son unless Schwade complied with the Plan by signing a subrogation agreement. Schwade refused. From August to November, 2007, the Plan sent Schwade an explanation of benefits denying each
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US Airways, Inc. v. McCutchen: Third Circuit Logic Fails to Hang Together

On November 16, 2011, a panel of the Third Circuit Court of Appeals decided US Airways v. McCutchen, No. 10-3836, 2011 U.S. App. LEXIS 22883 (3d Cir. Nov. 16, 2011). The Court claims to respond to the Sereboff court’s argument left open by footnote two in the Supreme Court’s decision
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Third Circuit Finds Place For Equitable Defenses To Subrogation Claims

Apparently, inspired by the recent Supreme Court decision in CIGNA v. Amara, the Third Circuit has held that the “appropriate equitable relief” qualifier in the grant of civil remedies under ERISA’s Section 501(a)(3) allows for the application of equitable defenses to plan reimburseme
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Third Circuit Finds Place For Equitable Defenses To Subrogation Claims

Applying the traditional equitable principle of unjust enrichment, we conclude that the judgment requiring McCutchen to provide full reimbursement to US Airways constitutes inappropriate and inequitable relief. Because the amount of the judgment exceeds the net amount of McCutchen’s t
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