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


  1. Regina Delph

    Hi everyone I had no idea something like this existed because I have nobody to speak to regarding issues like this. My mom passed so all I have is my father and my Kids.I received a full hysterectomy after I had a emergency c- section to deliver my twins because of a infection that started up 24 hours after my c- section high fever pain ect that carried on for little over a year ,i was told that it was a normal process with a c- section and constipation and of course I believe you are becoming addicted to pain meds ,bad pain ,bleeding heaving I couldn’t have sex with my husband I complained over a year and I guess the dr was Fed up with hearing and seeing me so I was put under for a laparoscopy to look around its suppose to be a quick one stich in the belly so I told my husband to go to work and I got a baby sitter to watch the kids and had my mom take me so I was put under and about 15 min later the dr came out and told my mom she has to sign for me to have a partial hysterectomy because I had a infection that was so bad that has surprised I didn’t and up in the hospital and he told my mother he was sorry but didn’t say a word to me ,i stayed in the hospital for 3 days in strong pain medication that was given every 4 min iv and my husband had to take off from his job so he lost money ,i was sent home on strong medication and was told to stay on top of my pain meds so my pain doesn’t bad, i was so glad I was feeling better I could play with my Kids so much better and out of the blue about three months later it all started back up why me I was thinking so I made another appt, so I want to my dr and after everything that happened things he said to me nothing is wrong it’s in my head and of course I was becoming addicted from pain meds and ect , the dr put me under again for the laper scope and found out the infection moved to the other so I had to have a full hysterectomy they had to take everything I stay three days stong pain meds again every four min iv pump.sent home stay on top up the pain,well from that point my pain never left I could have sex I was having accidents at night ,i couldn’t have a bowl movement by myself had to use something something to help me go,after all that being on pain meds off and on for years I became addicted, lost my husband my Kids went to live with there father because my addiction was so bad I lost so much and the moments I missed with my Kids I will never get back. I wanted to die and I even tried,i couldn’t stand myself I hated despised the who world my husband for leaving me ,i was just Fed up with life and I was a great mom I didn’t drink I didn’t use any drugs I couldn’t take flu meds sinus meds without being knock out on it,my life was my husband and my Kids and I lost it all ,do you know what it’s like to say to youself I’m not a good mom any more and I am putting my Kids in danger being on just so I loved my Kids so much I made my Kids go there with there father and it crused me I hated myself for being addicted to drugs but I had to get help and I had to do what was right to protect my Kids so I went to rehab and now almost two years but my relationship with my Kids doesn’t exist anymore my Kids hate me they will never forgive me and that’s killing me.

    1. Linda (Post author)

      Regina unfortunately this has happened all to often. You should not beat yourself up over your children and never stop trying to reconnect with them. Keep a diary. Pick up tiny things and write notes to go with them. One day you may have a chance to see them again and hand them everything. It could make all the difference.

  2. Beth

    Fight. Fight with all you got. Don’t give up on yourself. or your kids.

  3. Regina Delph

    Thank you!!! i will continue to fight, right now im trying to find attorney that will take my case on, two said no because i didn’t return to my ob about the problems with the mesh, i was told by my ob never to return ,we had few arguments over the hysterectomy because if he would’ve took the time to really hear me I wouldn’t be without ovaries uterus ,recovering addict and I would still have my kids, but i was seen multiple times in the er.fingers crossed on the third attorney.


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