ERISA and Health Insurance Subrogation in All 50 States - Sixth Edition
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ERISA and Health Insurance Subrogation in All 50 States is the most complete and thorough treatise covering the complex subject of ERISA and health insurance subrogation ever published.
Health insurance subrogation requires its practitioners to be familiar with applicable state law, with the nuances of health insurance subrogation in each state, but also with the treatment of health insurance subrogation through ERISA, as applied by the Federal District Courts, Federal Appellate Courts, and the U.S. Supreme Court. Familiarity with the general trends within each of the 12 Federal Circuits is also cited. This book is written to help inexperienced and seasoned subrogation professionals alike gain or improve upon their proficiency, by guiding readers through the complex and challenging world of health insurance subrogation in today’s insurance subrogation marketplace.
Written by one of the world's leading experts on insurance subrogation, this authoritative work, refined now in its Sixth Edition, is designed to be used by educators, professionals, or attorneys writing briefs or arguing their positions in various situations. It provides convenient summaries of each chapter, a detailed TOC, and chapters broken down by state, to make locating needed information easy. Key complex issues are explained in language that is easy to read and easy to digest.
Acknowledged as the preeminent work on ERISA and health insurance subrogation, the Sixth Edition of ERISA and Health Insurance Subrogation – In All 50 States contains the following NEW information:
• ALL the Newest Case Law
• Medicare, Medicaid and Medicare Advantage Subrogation
• New Plan Language Recommendations
• Complete Health Insurance Subrogation in ALL 50 States
• Application of ERISA in EVERY Federal Court
Completely rewritten and reorganized, the Sixth Edition of ERISA and Health Insurance Subrogation includes the following New chapters:
Chapter 2 – Subrogation Rights Of Fully-Insured and Self-Funded Health Plans
Chapter 4 – Employee Retirement Income Security Act (ERISA)
Chapter 6 – Defenses to Health Insurance Subrogation
Chapter 7 – Litigating ERISA Claims
Chapter 8 – Supreme Court Treatment of § 502(A)(3) Actions
Chapter 9 – Recovery of Benefits Paid by Mistake
Chapter 10 – Coordination of Benefits
Chapter 11 – Liability of Plaintiffs’ Counsel
Chapter 12 – Medicare, Medicare Advantage, and Medicaid Subrogation
Chapter 13 – Federal Employees’ Health Benefit Act (FEHBA) Subrogation
Presented for the first time in the new Sixth Edition of ERISA and Health Insurance Subrogation is:
- A detailed history of health insurance and its relationship to ERISA, including the trend towarr 8d employer-sponsored health insurance, the development of HMOs, ERISA and the growth of federal regulation of health insurance, Also new is the inclusion of new law, broken down by federal circuit, on the subrogation of capitated HMO Plans.
- How the 2009 Stimulus Bill (Title 13 of ARRA 2009) modifies HIPAA regarding privacy and security rules. The January 20, 2016 U.S. Supreme Court decision in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan is given considerable treatment and explanation in several chapters.
- A new chapter has been added to cover the fast-growing field of Medicare, Medicaid and Medicare Advantage subrogation. It covers and explains all of the newest cases in this field, including Collins v. Wellcare Healthcare Plans, Inc., Care Choices HMO v. Engstrom, In re Avandia Mktg., Sales Practices & products Liability Litigation, and Parra v. PacifiCare of Ariz., Inc.
- A new section on the Fair Debt Collection Practices Act provides a thorough treatment of both federal and state law fair debt collection laws, including summaries of the most significant case law dealing with what constitutes a “consumer debt” and whether and when subrogation must comply with fair debt collection practices requirements.
- Delves into the role which the Federal Anti-Injunction Act plays when beneficiaries sue in state court to enforce the terms of an ERISA Plan, while the Plan files suit in federal court seeking an injunction against the state court action.
- Expounds on the ability of a “prevailing party” to recover attorney’s fees, when a party is considered to have “prevailed”, and how the fees are to be calculated.
- A summary of new Office of Personnel Management rules clarifying subrogation and reimbursement rights of health Plans established under the Federal Employee Benefits Program.
- Goes into detail with regard to the nature of wrongful death and survival actions from state to state, focusing on a health Plan’s right of subrogation and/or reimbursement based on the nature of the damages being sought.
- A new subsection has been added to the Longshore and Harborworker’s chapter dealing with the lien and future credit rights of the LHWCA Special Fund.
- Chapter 11 has been rewritten, focusing specifically on the liability of plaintiff’s attorneys who settle tort cases without reimbursing a health Plan. Included in the rewritten chapter is an overview of the law in this area broken down by each federal appellate circuit.
- Expands on, summarizes, and parses the various causes of action and avenues of potential recovery a subrogated Plan has directly against the plaintiff’s attorney who recovers a settlement and disburses the settlement proceeds without reimbursing the Plan.
- Contains an expanded chapter on improving Plan language and includes many new suggestions and recommendations for sample Plan language.
Readers can be sure that with the Sixth Edition of ERISA and Health Insurance Subrogation
they possess an invaluable, practical resource that explores every area of importance to practitioners in the health insurance subrogation field.
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. 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.
"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