Subrogation/Reimbursement Claims

Messing v. Provident Life & Accident Ins. Co., No. 21-2780, __ F.4th __, 2022 WL 4115873 (6th Cir. Sept. 9, 2022) (Before Circuit Judges Clay, Rogers, and Kethledge)

ERISA provides that a plan participant, beneficiary, or fiduciary can sue to obtain “appropriate equitable relief.” 29 U.S.C. § 1132(a)(3). One of the thorniest issues

Good morning, ERISA Watchers!  There weren’t any notable circuit court decisions this past week, so we want to highlight a district court decision involving a health plan’s attempt to seek an equitable lien on personal injury settlement proceeds.  In Publix Super Markets, Inc. v. Figareau et. al., Case No. 8:19-cv-545, 2019 WL 6311160 (M.D. Fla. Nov. 25, 2019), Publix filed an ERISA action to obtain reimbursement for health benefits paid by its ERISA Plan.  Publix is the sponsor and administrator of its Group Health Benefit Plan, which provides medical expense benefits to eligible employees and dependents.  The Plan is self-funded, is not insured through commercial carrier health insurance, and includes a reimbursement provision.

Paul is a Publix employee and is enrolled in the Plan. Paul and Figareau are the parents of minor child L.P., who sustained an injury at birth. The Plan paid $88,846.39 in medical expense benefits related to her injury. Her parents retained Tejedor and the law firm Diez-Arguelles & Tejedor, P.A. (the “Attorney Defendants”) to bring a medical negligence action against the medical providers. The matter settled, and the funds were housed in a designated structured settlement account established by Paul and Figareau. There were additional funds that had been deducted from the gross settlement that either remained in the attorney Defendants’ trust account or are otherwise subject to the attorney Defendants’ possession and control. 
Continue Reading Court Permits Health Plan’s Equitable Lien Claim to Proceed Against Participant’s Attorneys