Subrogation

: : Duke Energy Benefits Committee Sues Law Firm & Plan Member in ERISA Reimbursement Case

Defendants have refused, despite numerous requests, to reimburse the Plan forbenefits the Plan paid on Heafner’s behalf out of Settlement Funds he received in connection withthe Accident. Defendants’ actions violate the terms of the Plan. Heafner has been unjustly enriched by her refusal to reimburse the Plan for themedical benefits it paid on his behalf. …

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: : Nationwide Class Action Discovery Permitted Against LTD Carrier In Recoupment Dispute

“[T]he only issue before the Court is whether discovery regarding potential class members outside of the state of Pennsylvania is relevant to Plaintiff’s claims under ERISA. Aetna argues that this discovery is irrelevant because Plaintiff’s asserts claims only under state law.  But Aetna misconstrues the allegations in the second amended complaint, which clearly assert that …

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:: ERISA Plan Cannot Rely on Equitable Remedies To Supplement Subrogation Provision

“As an initial matter, the Court notes that this case is somewhat unusual. As stated above, plans often contain reimbursement provisions which expressly entitle them to seek reimbursement from beneficiaries who receive both plan benefits and third-party compensation. Consequently, litigation regarding reimbursement provisions generally centers around questions of application (i.e., whether recovery should be limited …

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:: District Court Grants Plan Summary Judgment In ERISA Reimbursement Case

A Georgia U.S. district court has awarded summary judgment to an ERISA plan on its claims to reimbursement from funds acquired in a personal injury settlement.   In the Eleventh Circuit, plan language must conform to several requirements that are essentially judicial gloss on the ERISA statute.  This case illustrates a successful clearing of each hurdle. …

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:: Subrogation Claims In Complex Litigation – The Whole Is Less Than The Sum Of Its Parts

As a threshold matter, the Court recognizes that it is possible, even likely, that a significant portion of the settlement funds do–or, perhaps more accurately, will at some point in the future–belong to some of the Plaintiff health plans. Whether those funds belong in good conscience to the Plaintiffs at this stage of the settlement …

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:: Common Fund Doctrine Applied In ERISA Subrogation Case Where Plan Language Ambiguous

Unlike the subrogation clause analyzed in the Walker decision, the second part of the 1995-2006 SPD subrogation provision does not state in unambiguous terms what “the right to recover from the covered persons” encompasses; it uses no modifying terms such as “all,” “first lien,” “any recovery,” or “100% reimbursement.” Because the 1995-2006 SPD does not …

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:: The Conflict Between ERISA Overpayment Claims And Statutory Protection Of SSDI Benefits

he plaintiff also argues for dismissal of the counterclaim because MetLife seeks to recover funds received under the Social Security Act, which funds are protected from “execution, levy, attachment, garnishment, or other legal process.” See 42 U.S.C. § 407. For support, the plaintiff cites Ross v. Pa. Mfrs. Ass’n Ins. Co., No. Civ.A 1:05-0561, 2006 …

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:: New Scholarship On Common Fund Doctrine Application To ERISA Subrogation Cases

Courts have not uniformly resolved whether state common fund doctrines are expressly preempted by ERISA; some courts have found express preemption, while others have not. Many courts have simply concluded, without even performing a preemption analysis, that plan language can invalidate otherwise applicable state law establishing the common fund doctrine. Applying the Common Fund Doctrine …

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