No more paying back liens to your Health Insurance Co when you settle your case!

OK, we finally put the nail in the coffin on ERISA subrogation claims! Those nasty vultures at Rawlings are truly out of our lives ! (Actually, calling them “vultures” is an insult to such noble birds who actually contribute something to the world!) “Pirates” is another word that came to mind, but I don’t think that true pirates plundered as indiscriminately as Rawlings!

In Wurtz v. The Rawlings Company, — F.3d—, 2014 WL 3746801, the U.S. Court of Appeals for the 2nd Circuit rendered a major decision yesterday, 7/31/14, holding that New York’s antisubrogation law is “saved” by ERISA’s “saving clause” and applicable to health insurers providing coverage through ERISA plans. This is a significant victory for ERISA participants and beneficiaries.

The underlying action was filed as a class action in New York State court against The Rawlings Company, LLC; Oxford Health Plans (NY), Inc.; and UnitedHealth Group, Inc. alleging violations of New York law relating to efforts to secure reimbursement of medical benefits from plaintiffs’ tort settlements.

The defendants removed the case to federal court and the federal trial judge dismissed it on the basis of ERISA preemption.  The 2nd Circuit reversed and remanded, holding that neither “complete preemption” nor “conflict preemption” were applicable to the plaintiff’s claims seeking enforcement of state law which is saved by ERISA’s “saving clause.”

The Court relied upon the 1990 Supreme Court decision in FMC v. Holliday and noted that its ruling “is in some tension with holdings of the Third, Fourth, and Fifth Circuits in similar antisubrogation cases.”

In responding to the assertion that subrogation/reimbursement was required to uphold national uniformity under ERISA, the Court stated,
Allowing plaintiffs’ state-law claims under [New York statute] section 5-335 to proceed will not disturb ERISA’s goal of providing national uniformity. ERISA has strong preemptive provisions, the purpose of which are “to provide a uniform regulatory regime over employee benefit plans.” Davila, 542 U.S. at 208. But “ERISA says nothing about subrogation provisions. ERISA neither requires a welfare plan to contain a subrogation clause nor does it bar such clauses or otherwise regulate their content.” Member Servs. Life Ins. Co., 130 F.3d at 958 (internal quotation marks omitted). Because ERISA is silent on subrogation, our decision does nothing to disturb ERISA’s goal of national uniformity in employee benefit plan regulation.

Good riddance!

Leave a Reply

Your email address will not be published.