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States Can Subrogate but Health Insurers Cannot: Kansas House Bill 2750 & Arizona Senate Bill 1043

Kansas and Arizona both presently prohibit health insurance companies from seeking subrogation recoveries within their states.  Interestingly, both states introduced legislation to allow their state funds or programs to seek recovery of their payments through subrogation and/or reimbursement. 

Kansas seeks to allow its state employee fund to pursue subrogation rights and reimbursement from its employees.   The Kansas bill would provide the underlying plaintiff attorney a fee of either 33-1/3 or 40% from any recovery by the state health plan.  It also establishes coordination of benefits as a matter of law. 

Arizona Senate Bill 1043 was enacted on May 6, 2010.  The bill creates for the State of Arizona the “Children’s Health Insurance Program” (CHIP).  The law grants the State subrogation rights “against any other person or firm to enforce the assignment of medical benefits.”  Section 36-2986, subsection A, paragraph 8.  With the new CHIP program the legislature has created subrogation rights for the State of Arizona to ensure they remain the payor of last resort.  This law is an example of a state using subrogation to further advance public policy and provide benefits to the citizens of its state as well as assistance in controlling costs.   

As reported by the Amicus Committee for the National Association of Subrogation Professionals, Weltman, Weinberg and Reis, Co., LPA member.

Louisiana Senate Bill 578

The proposed bill limits Health Subrogation & Creates Extra Contractual Liability on P&C Insurers Louisiana is considering a bill to prevent auto, property and workers compensation insurers from paying health plan or health insurers their subrogation liens.  The bill requires such P&C carriers to first obtain the written consent of the health plan or insurer’s “insured” or their “legal representative.”   The bill provides that any suit to enforce this obligation include payment of the attorney fees for bringing the case.  Practically speaking, the bill will make health subrogation nearly impossible.  Health carriers’ rights to reimbursement will be clearly dependent on their insureds’ consent.  The bill gives no instructions, explanations, information or bases for why and when an insured may withhold consent.  Under the present wording, an insured could withhold their consent for a reasonable perceived basis or merely a whim.  Such legislative ambiguity will in turn have a chilling effect on health care subrogation in the state. The bill also creates extra-contractual liability on the part of any auto, property or workers compensation companies that pay such healthcare subrogating claims without such written consent.  Senate Bill 578 will have hearings shortly in Louisiana.

As reported by the Amicus Committee for the National Association of Subrogation Professionals, Weltman, Weinberg and Reis, Co., LPA member.

Subrogation under Attack – Legislative Update

Colorado – House Bill 10-1168.  The Colorado House has proposed a bill that would dramatically alter the subrogation landscape in the state.  The bill essentially codifies the “made whole” and “common funds” doctrines which is a disturbing trend being witnessed in the courts and the legislatures throughout the country.  As stated in Section 3(a):

 Reimbursement or subrogation pursuant to a provision in an insurance policy, contract or benefit plan is permitted only if the injured party has first been fully compensated for all damages arising out of the claim.  Any provision in a policy, contract or benefit plan allowing or requiring reimbursement or subrogation in circumstances in which the injured party has not been fully compensated is void against public policy.

 The proposed Act also seeks to preclude the right of the carrier to bring their own cause of action against the tortfeasor for benefits paid to their insured.  Section 6(a)  provides:

 A payer of benefits shall not bring a direct action for subrogation or reimbursement of benefits against a third party allegedly at fault for the injury to the injured party or an insurer providing uninsured motorist coverage.

 Additionally, if an insurer obtains reimbursement of benefits paid, the insurer must apply the amount of the reimbursement as a credit against any applicable lifetime cap on benefits contained in the applicable policy or plan.

 South Dakota – Senate Bill 169.  A recent amendment to the Insurance Code in South Dakota looks to continue the “made whole “ activist trend in subrogation legislation.  The amendment is one sentence long and provides, “No insurer under this chapter is entitled to participate in any recovery from any tortfeasor on account of bodily injury or death or damage to property unless and until it’s insured has first been made whole.”  This amendment to the Insurance Code would apply to health, worker’s compensation, auto and property insurers.  Due to the brevity of this proposed amendment there will be many questions left unanswered if this bill passes.  The first that comes to mind is what is meant by “has first been made whole”.  Such a broad use of words is open to much interpretation, much of which can be construed negatively against the insurer, which the South Dakota courts will need to interpret as time goes by if this amendment is passed.

 The South Dakota amendment and Colorado bill continue the recent trend in the legislatures to limit an insurers’ right to subrogation.  As with the just passed New York act and the recently tabled Ohio bill, the nations’ legislatures are becoming increasingly more active in attempting to invalidate at worst and cripple at best an insurers’ right to subrogation.  Feel free to contact us for additional updates on these issues and to determine what actions you can take to help stem the recent tide of legislative enactments designed to reduce the right of subrogation.

An attorney who settles a 3rd party action and does not preserve an ERISA plan lien may be personally liable for reimbursement of the lien to the plan.

The Federal District Court in Oklahoma found that an attorney who represents a plan participant in a third party action may be liable to the ERISA plan if he does not preserve the ERISA plan medical lien in a third party settlement.  The court recognized that ERISA created remedies that are equitable in nature, including the imposition of a constructive trust over settlement proceeds.  As a matter of law, the court found that an ERISA plans right to subrogation can extend to an attorney who fails to protect an ERISA medical lien by distributing settlement funds without reimbursing the plan.  The court found that a factual determination still needs to be made to decide if the attorney breached his fiduciary obligation to the plan by acting in concert with the plan participants to avoid the ERISA plan lien.

 

Pioneer Telephone Cooperative, Inc. v. Terry, et al¸ 2009 U.S. Dist. LEXIS 106606 (2009)

Filed:  November 16, 2009