If you have been in a collision and received medical care that was paid for by your own health insurance company, you may be in for a surprise. Your health insurance company will likely want its money back, if you collect compensation from the other driver.
Even worse, your health insurance company may want it all.
The Supreme Court agreed Monday to determine whether an employee benefits plan is subject to equitable limitations when it demands reimbursement of benefits paid a covered employee who recovers money from third parties.
James McCutchen, a 51-year-old U.S. Airways employee, was seriously injured in an automobile accident when a young driver lost control of her vehicle and struck the car he was driving. As a result of that crash, a truck traveling behind McCutchen slammed into his car. One person was dead and two others were left with severe brain injuries.
McCutchen was seriously injured and survived only after emergency surgery. He had a complete hip replacement and then spent several months in physical therapy.
Since the accident, McCutchen has undergone a series of back surgeries, suffers from chronic pain and is functionally disabled.
In the aftermath of the crash, U.S. Airways, through its ERISA benefits plan, paid $66,866 to cover McCutchen's medical expenses.
In the meantime, McCutchen sued the driver that caused the accident and settled for the available automobile insurance coverage, but the net amount was less than $66,000. However, U.S. Airways then sought reimbursement from McCutchen's settlement for the entire $66,866 that U.S. Airways paid in medical expenses. U.S. Airways claims the language in its benefits plan permits it to recoup the $66,866 it provided for McCutchen's medical care out of the total he recovered, regardless of his legal costs, his pain, suffering and impairment.
What U.S. Airways wants is a transfer of money between insurance companies, with McCutchen receiving nothing. Because McCutchen had to pay attorney's fees and litigation costs to obtain the settlement, and U.S. Airways contends that it need not contribute to those expenses, McCutchen would actually be worse off than if he had not filed suit against the negligent person who caused the wreck.
We will be watching this one closely. A Supreme Court decision in favor of employee benefit plan and health insurance reimbursement would be very detrimental to Americans who want negligent drivers to be held accountable and responsible.
Even worse, your health insurance company may want it all.
The Supreme Court agreed Monday to determine whether an employee benefits plan is subject to equitable limitations when it demands reimbursement of benefits paid a covered employee who recovers money from third parties.
James McCutchen, a 51-year-old U.S. Airways employee, was seriously injured in an automobile accident when a young driver lost control of her vehicle and struck the car he was driving. As a result of that crash, a truck traveling behind McCutchen slammed into his car. One person was dead and two others were left with severe brain injuries.
McCutchen was seriously injured and survived only after emergency surgery. He had a complete hip replacement and then spent several months in physical therapy.
Since the accident, McCutchen has undergone a series of back surgeries, suffers from chronic pain and is functionally disabled.
In the aftermath of the crash, U.S. Airways, through its ERISA benefits plan, paid $66,866 to cover McCutchen's medical expenses.
In the meantime, McCutchen sued the driver that caused the accident and settled for the available automobile insurance coverage, but the net amount was less than $66,000. However, U.S. Airways then sought reimbursement from McCutchen's settlement for the entire $66,866 that U.S. Airways paid in medical expenses. U.S. Airways claims the language in its benefits plan permits it to recoup the $66,866 it provided for McCutchen's medical care out of the total he recovered, regardless of his legal costs, his pain, suffering and impairment.
What U.S. Airways wants is a transfer of money between insurance companies, with McCutchen receiving nothing. Because McCutchen had to pay attorney's fees and litigation costs to obtain the settlement, and U.S. Airways contends that it need not contribute to those expenses, McCutchen would actually be worse off than if he had not filed suit against the negligent person who caused the wreck.
We will be watching this one closely. A Supreme Court decision in favor of employee benefit plan and health insurance reimbursement would be very detrimental to Americans who want negligent drivers to be held accountable and responsible.
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