A recent decision by the U.S. Court of Appeals for the Sixth Circuit (Patterson v. United HealthCare Ins. Co., No. 22-3167, 2023 WL 4882436 (6th Cir. Aug. 1, 2023)) illustrates the importance of clearly describing key plan terms in the plan document and summary plan description. Incomplete documentation or disclosure can
Subrogation
Ninth Circuit Enforces Hawaii Anti-Reimbursement Statutes Against Insured Plan
By Russell Hirschhorn & Kyle Hansen on
ERISA health care plans typically include reimbursement and subrogation clauses, which give plans a right to reimbursement of medical expenses paid on behalf of a beneficiary where the injury is caused by a third party. While such provisions are common in ERISA health care plans, they sometimes conflict with state laws that prohibit plans and…
U.S. Supreme Court Holds ERISA Plan Cannot Enforce Equitable Lien Against Participant’s General Assets
By Joseph Clark on
Earlier today, the U.S. Supreme Court reversed a decision by the Eleventh Circuit and held that when a ERISA plan participant obtains a third-party settlement subject to a plan’s subrogation provision, and then dissipates the settlement on “nontraceable” items, the plan cannot enforce a lien against the participant’s general assets under Section 502(a)(3) of ERISA. …
Sixth Circuit Enforces Subrogation Clause
By Neil V. Shah on
The Sixth Circuit rejected a participant’s argument that the plan’s subrogation provision was not enforceable because it was only in the plan’s summary plan description, and not in the trust agreement that the participant argued was the operative plan document. The Court determined that the subrogation provision was contained within a document that served as…