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Author Archives: Sara E. Hauptfuehrer

U.S. AIRWAYS V. MCCUTCHEN: IS IT “FAIR” FOR YOUR HEALTH PLAN TO ENFORCE ITS REIMBURSEMENT RIGHTS?

By Sara E. Hauptfuehrer | Published: January 23, 2012
Group health plans typically provide that when the plan pays benefits for treatment of injuries incurred as the result of a third party’s negligence, the plan is entitled to reimbursement for those payments from the proceeds of injured participant’s recovery (if any) from the third party.  In general, those kinds of provisions are enforceable under [...]
Posted in Employee Benefits/ERISA | Leave a comment

HEALTH CARE REFORM – EXTERNAL REVIEW PROCEDURES

By Sara E. Hauptfuehrer | Published: October 6, 2011
The Patient Protection and Affordable Care Act (“PPACA”) requires health insurance issuers and certain employer-sponsored group health plans to comply with “the applicable State external review process for such plans and issuers.”  States’ external review processes must provide for external review of denials of insurance claims (and claims for group health plan benefits) for medical [...]
Posted in Employee Benefits/ERISA, General Employer Interest | Leave a comment

THE SUPREME COURT RELAXES THE STANDARD FOR AWARDS OF ATTORNEYS’ FEES IN ERISA CASES. BUT DOES IT REALLY MATTER?

By Sara E. Hauptfuehrer | Published: May 9, 2011
As a general rule, under what is called “the American Rule” each party to a lawsuit pays his own attorney’s fees, win or lose, unless a statute or a contract provides otherwise.  The Employee Retirement Income Security Act (“ERISA”) authorizes courts to award attorneys’ fees and costs to either party.  Such “fee-shifting” is not automatic [...]
Posted in Employee Benefits/ERISA | Leave a comment

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