Health Insurance & Lawsuits
Surely there’s more blood in this stone.
Someone just sent me an article that she thought could affect some women who have tort lawsuits. I never could understand why injured people have to pay back insurance companies when they have paid out huge monthly insurance premiums in the first place. To me it seems like double dipping and a win, win for insurance providers. There seems to be one rule for insurance providers and we have no say in the matter.
The following ruling came down the 20th January 2016. Here is part of it and I will give you the link for the entire story.
The Supreme Court delivered a blow to insurance plans and a victory to injured beneficiaries in an 8-1 decision Wednesday that limits the circumstances under which plans may recover money from beneficiaries who win cash in court for their injuries.
The Supreme Court ruled in Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan (PDF) that if a plan’s beneficiary wins money in court for an injury but then spends it all, the plan may not then sue the beneficiary to recover the medical expenses it paid. The ruling applies to plans governed by a federal law known as ERISA, which includes plans provided by private employers.
Doug Haloftis, a partner at Barnes & Thornburg, said Wednesday was “not a good day for plans and, really, overall plan participants in general.”
“If the plans lose billions of dollars, it causes plan participant costs, in terms of premium dollars to go up,” Haloftis said.
The case arose after a drunk driver in Florida slammed into Robert Montanile’s vehicle in 2008. Montanile won $500,000 in court, but then spent it all on ongoing medical expenses, lawyers’ fees and his young daughter.
His health insurance administrator, however, argued that Montanile still had to reimburse it for the money it spent on his care, regardless of whether he had already spent the $500,000.
The decision shields injured beneficiaries from financial ruin, said Dana Berkowitz, an attorney for Montanile and a partner with Stris & Maher.
Robert Betts, executive director of the National Elevator Industry Benefit Plans, which administers collectively bargained employee benefits, declined to comment Wednesday morning.
Will this affect any tort cases? I honestly don’t know but I doubt it.
But in court documents the administrator had argued that plans should not have to spend their limited resources paying medical bills that should be paid by the wrongdoer. It’s common for insurance plans to include provisions requiring beneficiaries to reimburse them for costs of medical treatment should they win money in court for their injuries.
Since when do the wrong doers pay up after people are injured? Well when it comes to mesh injuries, Insurers only pay 80% of the bill and the injured person faces the 20%. Medicare only pays 80% and I personally have to pay out $150 a month out of my Social Security which is very limited, to cover the other 20%. I got that down this year from $170 a month by changing companies. However, had I had more surgeries it would have gone up higher. It is either pay up first by insurance or go bankrupt. Yes, the U.S really cares about its older generation.
Plans pull in more than $1 billion a year in such reimbursements, the administrator said. Allowing beneficiaries to avoid making those payments could raise costs for insurers, and in turn, beneficiaries, the administrator argued.
Here’s the deal. I know the CEO’s of these companies make huge bucks as salaries.
However they always pass the buck on to the people. You can bet your boots a lien will be placed on EVERY medical court case from now on and I believe they already do it on tort lawsuits so there is no getting out of paying. So don’t get your hopes up. They want it all……………
Here is the link