ERISA and Health Insurance Subrogation - In All 50 States - 3rd Edition
Gary Wickert
Price: $225.00 1000 pages. 1 Hardcover Volume. Table of Authorities. Index. To be Published September 2008. Revised 3rd Edition Coming Soon. Pre-Order your Copy today.
ISBN-13: 978-1-57823-247-5
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| ERISA and Health Insurance Subr. - In All 50 States - 3rd Ed $225.00 |
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What’s New in the 3rd Edition:
About the Book:
ERISA and Health Insurance Subrogation is the most complete and thorough treatise covering the complex subject of ERISA and health insurance subrogation ever published. Unlike most areas of insurance litigation/subrogation, health insurance subrogation requires the subrogation professional to be familiar not only with applicable state law and the many vagaries and nuances of health insurance subrogation within each state, but also the treatment of health insurance subrogation through ERISA, as applied by Federal District Courts, Federal Appellate Courts, and the United States Supreme Court. Familiarity with the general trends within each of the 12 Federal Circuits is also cited. This book is intended to introduce the health insurance claims handler, in-house counsel and subrogation professional to the complex and challenging world of health insurance subrogation in today’s insurance subrogation marketplace.
The following issues and topics are covered in detail for each of the 50 states and all Federal Circuits:
Types of Subrogation
• Conventional (Contractual) Subrogation
• Legal (Equitable) Subrogation
• Statutory Subrogation
• Difference Between Subrogation and Assignment
• Role of Equity
• Hospital Liens
• Medicare
• Other Statutory Subrogation Rights
Non-ERISA Health Insurance Subrogation
• Common Fund Doctrine
• Contributory Negligence
• Indemnification Agreements
• Indemnity Versus Investment Contracts
• Made Whole Doctrine
• Mandatory Joinder of Parties
• Medical Subrogation Generally
• Releases and Settlement Checks
• Statutes of Limitations
• Subrogating Against Municipalities
• Under/Uninsured Motorist Carrier Recoveries
Complete Summary of Health Insurance
Subrogation in All 50 States
• Anti-Subrogation Statutes
• Collateral Source Rule
• Common Fund Doctrine
• Complete Statutes of Limitations
• Contractual Subrogation Rights
• Equitable Subrogation Rights
• Historical Treatment of Health Insurance Subrogation
• Interface with No-Fault Insurance Laws
• Limitation on Recovery
• Notice Requirements
• Rights of Reimbursement
• Rights of Subrogation
• Statutory Subrogation Rights
• Treatment on Made Whole Doctrine
• Wrongful Settlement
ERISA-Covered, Self-Funded Employee Medical Benefit Plan Subrogation
• Allocation of Recovery Among Beneficiaries
• Church Plans
• Exclusions from ERISA
• Federal Common Law
• Gerrymandered Settlements
• Government Plans
• History and Scope of ERISA
• HMO Plans
• Multi-Employer Plans
• Occupational Accident Plans
• Recovery Priorities
• Reimbursement Agreements
• Reimbursement Rights
• Rights of Subrogation Under ERISA
• Role of Plan Fiduciaries and Third Party Administrators
• Sample ERISA Plan Language
• Self-Funded Plans Versus Insured Plans
• Stop-Loss Coverage
• Subrogation Receipts
• Summary Plan Descriptions
• Trade Association Plans
• Trust, Contract and Labor Law Parallels
• Types of Subrogation Provisions
Preemption
• Complete Preemption
• Conflict Preemption
• Erosion of Preemption
• Preemption, Savings and Deemer Clauses
• State Law Relation to Employee Benefit Plans
Made Whole Doctrine Under ERISA
• As Effected by Plan Administrator’s Interpretation
• As Effected by Settlements
• Effected by Reimbursement Provisions
• Made Whole Doctrine as Default Rule
• Plan Cooperation Clause
• Presumptions Against Made Whole Doctrine
• Self-Funded Plans
• Specific Plan Language Involving Made Whole Doctrine
• Summary of Made Whole Doctrine by Federal Circuit
Common Fund Doctrine
• Absence of Plan usage.
• As Effected by Plan Language
• As Effected by Plan Administrator’s Interpretation
• Common Fund Doctrine under Federal Common Law
• Full Reimbursement Language
• Who May Raise Common Fund Claims
Other ERISA and Preemption Issues
• Anti-Subrogation Statutes
• Collateral Source Rules
• Common Fund Doctrine Statutes
• Lien Reduction Statutes
• Federal Common Law
• Federal Employee’s Health Benefit Act
• Laws Regarding Minors
• Medical Malpractice Recoveries
• No-Fault Insurance Laws
• Other State Statutes
• Regulation of Insurance Tests
• State Collateral Source Rules
Conversion of ERISA Subrogation Interests
• Breach of Fiduciary Duty
• Breach of Plan Terms
• Effective Release
• Implied Partnership
• Jurisdiction
• Plaintiffs’ Attorney’s Ethical Considerations
• Recovery of Same
• Tortuous Interference
• Unjust Enrichment
Enforcing Subrogation Rights Under ERISA
• Authority Under ERISA Plan
• Case Decisions
• Persons Who Can Pursue Subrogation
• Statutory Authority for ERISA Enforcement
• Venue
Analysis & Application of Knudson and Sereboff Decisions
• Knudson confusion made clear
• Treatment of Knudson in each federal circuit
• Detailed explanation of Sereboff decision
• Practical ramifications of Sereboff
•Plan language changes needed as a result
Intervention and Jurisdiction
• Abstention
• Broad View
• Intervention
• Jurisdiction
• Narrow View
• Removal
• State Court Jurisdiction After Knudson
• Statutes of Limitation
Improving Plan Language
• Examples of Good Plan Language
• Examples of Poor Plan Language
• Improving Plan Language to Maximize Subrogation Recoveries
• Plan language changes recommended in light of Sereboff and Knudson
Using Subrogation to Manage Healthcare Costs In addition to being an excellent primer on health insurance subrogation, suitable for both the new subrogation professional and seasoned veteran, the book also contains a detailed synopsis of the health insurance subrogation laws in all 50 states, and all 12 Federal Circuits. It is a must for anyone with multi state subrogation responsibilities. Complete with diagrams, references, and thousands of footnotes, this is the most ambitious health insurance subrogation project ever undertaken.
Praise for ERISA and Health Insurance Subrogation
"A difficult and confusing subject made simple. If you have health insurance subrogation
responsibilities, you need this book."
-Loren Smith, Kelly, Smith & Murrah, P.C."When I entered the unsettled world of occupational accident plan subrogation, this book
helped me find the answers."
-Beth Cipollo, Cambridge Integrated Services Group, Inc."As a lawyer, I can tell you that this book is essential to maximizing our clients’ subrogation
recoveries. Don’t settle another subrogation claim without it."
-David Gagliardi, Cambridge Integrated Services Group, Inc."Every lawyer and claims adjuster responsible for subrogation should get a copy of this book
before handling another health insurance file."
-Daniel J. Offenbach, Leahy, Eisenberg & Fraenkel, Ltd."This book is the bible on health insurance subrogation. No claims handler should be
without it."
-Barbara McCoy, Self-Insured Services Company (SISCO)"This incredible book is the how-to guide for health insurance subrogation in all 50 states."
-Julia Chavarria, PFL Life Insurance Company
About The Author:
Gary Wickert is an insurance trial lawyer and is regarded as one of the world’s leading experts on insurance subrogation. He is also the author of several subrogation books and legal treatises and is a national and international speaker and lecturer on subrogation and motivational topics. He is also a published commercial fiction author (“Dark Redemption” at Amazon.com) and a politician in Wisconsin, recently elected to and serving his third term as Supervisor in the Township of Cedarburg. After 15 years as the youngest managing partner in the history of the 30-lawyer Houston law firm of Hughes, Watters & Askanase, L.L.P., Mr. Wickert returned to his native Wisconsin in 1998 and co-founded the subrogation firm of Matthiesen, Wickert & Lehrer, S.C. He oversees a National Recovery Program which includes a network of nearly 285 contracted subrogation law firms in all 50 states, Mexico, Canada and the United Kingdom and boasts recoveries of more than $500 million in recoveries and credits for more than 200 insurance companies. Licensed in both Texas and Wisconsin, Mr. Wickert is double board-certified in both personal injury law and civil trial law by the Texas Board of Legal Specialization. He is also certified as a Civil Trial Advocate by the National Board of Trial Advocacy, for whom he has both written and graded the product liability questions contained on the NBTA national certification exam taken by trial lawyers around the country. For 25 years, Mr. Wickert has served as an expert witness and insurance consultant on subrogation and insurance related issues and has been consulted by insurance carriers, lawyers, and legislative bodies from several states. He is a licensed arbitrator and has attended more than 750 mediations in more than 30 different states. He has represented subrogated insurance carriers in every state, and has been admitted pro hac vice in 17 states. Gary Wickert has worked with the Texas Legislative Oversight Committee in rewriting their workers’ compensation subrogation statutes, has served on the Board of the National Association of Subrogation Professionals, and has been cited as an authority on workers’ compensation subrogation by several appellate courts, including the Texas Court of Appeals. He is one of only a few lawyers to have ever represented a subrogated carrier before the United States Supreme Court, and was named as one of Law & Politics magazine’s Super Lawyers for 2005, 2006, and 2007.