How Did MASSIVE Resolve a Self-Funded ERISA Lien of $894,301 for $0.00?

We obtained the plan documents and determined it was not truly a self-funded ERISA plan. We don’t know whether the subrogation company intentionally represented it as a self-funded ERISA lien. Once the subrogation company realized we knew what we were doing, they offered to reduce the lien by half. We did not accept their offer. Instead, we continued to dispute and finally reached the Plan’s legal department with our argument. After lengthy discussions, the Plan ultimately acknowledged it must waive its entire lien.

Obtaining and reviewing a Plan document is one of the most important and beneficial actions an attorney can take when resolving a subrogation lien. Medicare, Medicare Advantage, State Medicaid, Managed Medicaid, TriCare and Veterans Administration subrogation all have statutory rights to their reimbursement and a Plan document is not needed. However, insurance plans and, more specifically, self-funded ERISA plans, are legally required to provide a copy of their Plan documents.

The most important reason to review the Plan documents is to determine which law will apply – State or Federal. States laws tend to be more favorable to a Plan beneficiary (your client). Additionally, the U.S. Supreme Court has given self-funded ERISA plans the power to enforce their very strong rights. However, the Plan must have these rights spelled out in their plan documents. Additionally, a contractual insurance plan must also have specific enforceability in its health contract. Occasionally, ERISA and health plans seek reimbursement while having no rights or limited rights. The Plan documents MUST be reviewed in all situations to ensure the Plans rights and a client’s obligations.

Master Plans, Summary Plan Descriptions, Form 5500, Schedule A, Schedule C and insurance contracts can be very overwhelming and confusing to review. MASSIVE and its attorneys and staff are experts in Plan language review. We thoroughly review all the necessary Plan documents to ensure our clients are not reimbursing an improper lien. Please contact us for assistance with your ERISA liens, or any other health insurance liens.