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Repaying your health insurance company

6/26/2012

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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.
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Toyota fires in the power window switch

6/18/2012

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The National Highway Traffic Safety Administration is investigating whether 1.4 million Toyotas and over 300,000 General Motors SUVs may have defective power-window switches that could lead to smoke and fire conditions.

The investigation of Toyota vehicles includes the 2007-9 Camry, Camry Hybrid, RAV4 and Yaris, as well as the 2008 Highlander Hybrid. The agency is investigating 2006-7 Chevrolet TrailBlazers, though it said would consider sibling vehicles like the GMC Envoy as well.

In a report recently posted on its Web site, the safety agency said it had knowledge of 161 fires, resulting in nine injuries. The volume of known fires warranted the intensification of the inquiry as well as its expansion to 1.4 million vehicles.

Toyota said its internal investigation suggested that owners or mechanics might have used over-the-counter lubricants, like silicone, on the switch, which could have caused a malfunction.

If you detect a melting, burning smell or see flames, turn off the ignition and exit the car.  Toyota said the defect did not pose “an unreasonable risk to vehicle safety.”
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Jeep fires

6/15/2012

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Three years ago, the Center for Auto Safety petitioned the National Highway Traffic Safety Administration to recall some three million Chrysler Jeep Cherokees from model years 1993-2004, after the group’s Fatality Analysis Reporting System revealed that the vehicles have “a fatal crash-fire occurrence rate that is about four times higher than S.U.V.’s made by other companies.”

Specifically, the group’s petition says, “the plastic fuel tank on 1993-2004 Grand Cherokees is not adequately protected from a rear impact because it is behind the rear axle.  The Grand Cherokee underwent a redesign in 2005, which involved putting the fuel tank in a safer location. 

Yesterday, NHTSA expanded its probe into the fires by adding Liberty and older Cherokee models to the probe.

If you or a loved one is involved in a crash where there is a vehicle fire, you should preserve the vehicle.  Do not sell it to an insurance company as a part of a settlement.  The vehicle may be important evidence that will help determine the cause of these fires and make sure that future vehicles will be safer.
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    Author

    Scott Brazil is an attorney in Houston, Texas, who is board certified in Personal Injury and Civil Trial Law by the Texas Board of Legal Specialization.

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