Are Self-Funded ERISA Plans All That Scary?
The short answer is – they can be. But if you know how ERISA Plans operate you can achieve maximum reductions.
Resolving liens can be a difficult and time-consuming task. Medicare frequently includes unrelated claims, but is statutorily required to reduce by a pro-rata share of attorney’s fees and costs. Insured health plans typically reduce by a pro-rata share of fees and costs as well. Even Medicaid plans offer reductions once a case settled. But, given recent power via the US Supreme Court, self-funded ERISA Plans are increasingly saying no to reductions of their liens.
Some common ERISA Plan responses are:
“The Plan has to consider all of the Plan members and not just your client. If we offer a reduction to your client, all of the other plan members suffer as their rates will go up.”
“Sorry but our Plan has strong language and is not required to reduce.”
“I understand your position, but this Plan disagrees and will not agree to a reduction.”
The key to getting a reduction is knowing ERISA law and reviewing all aspects of the Plan to find the weaknesses. Can we get state law to apply? Does the Plan disavow the Made Whole rule properly? Is the Plan truly self-funded? Is there separate subrogation and reimbursement provisions, and why does that matter? These, and more, are all very important questions you must ask on every ERISA lien.
The attorneys at MASSIVE have reviewed hundreds of self-funded ERISA Plans to craft these arguments and have even participated in helping draft plans. If you are not 100% positive you are able to handle the ever-changing world of self-funded ERISA law, why not consider someone who can assist with this task and allow you to handle the other important daily activities of your cases? See a case study of how we successfully reduced a complicated ERISA lien here.
Many firms don’t plan for lien resolution as early as they could. If you are anticipating an upcoming settlement, have settled cases which you’d like to disburse, or simply have questions about lien resolution such as when or how to begin, please contact us at 833 -GO-MASSIVE and discover how MASSIVE can deliver exceptional results for you.