TPA of Self-Insured Health Plan Not Subject to Texas Prompt-Pay Law

From the February 18, 2016 EBIA Weekly [Health Care Serv. Corp. v. Methodist Hosps. of Dallas, 2016 WL 530680 (5th Cir. 2016)] Available at http://www.ca5.uscourts.gov/opinions/pub/15/15-10154-CV0.pdf The Fifth Circuit has ruled that a third-party administrator (TPA) of employer-spons
Continue Reading →

TPA’s Beware of Fiduciary Liability

I read with interest Steve Polino’s “From the Bench” column in the February 2013 issue of The Self-Insurer and agree that the court finally got it right. Hopefully all TPAs will take note of this Fifth Circuit Court decision and adjust their administrative practices accordingly. While
Continue Reading →

Choice of Law In ERISA Disputes – How State Law May Affect Outcomes On Judicial Review

Here, the Policy contained a valid choice of law provision, which indicates that the parties intended for the Policy to be governed by Texas law to the extent that it is not preempted by ERISA. Thus, in order to decide this issue, we must ascertain how to determine whether or not to e
Continue Reading →

ERISA Reimbursement Claims Versus Special Needs Trusts

FKI and ACS rely on Bombardier for the proposition that a benefit plan can recover from a third party that is holding the funds “on behalf of a plan-participant client who is a traditional ERISA party.” Id. at 353. However, that is not the case here, because unlike the attorney in Bom
Continue Reading →

Fifth Circuit Permits ERISA and State Law Claims Against United Healthcare

The United States Court of Appeals for the Fifth Circuit, reversing a lower court decision, has ruled that ERISA does not preempt certain state statutory and common law claims for negligent misrepresentation and other unfair and deceptive practices. Read More..
Continue Reading →