Employer-provided health care coverage plans are governed by the Employee Retirement Income Security Act of 1974 (ERISA). Under ERISA, employers may decide to cover the medical expenses of their employees and their families. They may purchase a health insurance policy and pay a premium, or they may set up a “self-funded” or “self-insured” plan.
What Is A Self-Funded Plan?
A plan is “self-funded” if the benefits it pays come out of a pool of money collected from the plan’s own funds, from employee contributions or from both. A plan is “self-insured” if it pays benefits out of its funds, but the money comes from the employer’s general funds and not from a separate pool. “Self-funded” and “self-insured” plans may be referred to as “employer-funded” plans. Additionally, an ERISA plan may hire a third party, even an insurance company, to administer a self-funded or self-insured plan.
Employers that purchase an insurance policy may not seek subrogation. However, some employers with “self-funded” and “self-insured” plans may be entitled to seek subrogation out of your recovery.
What You Can Expect From Our Erie Lawyers
At the Quinn Law Firm, your lawyer must determine which category of health care coverage you have and whether ERISA applies. Your lawyer must then see if your plan document retains a right to seek subrogation out of your recovery. Employer-funded health plans must expressly reserve the right to seek subrogation.
If you do get a recovery or enter into a settlement and have not addressed the subrogation issue, severe consequences may result, and you may find yourself with far less than you expected. A settlement offer may sound like a big number at first, but remember: Your attorney’s fees and expenses, as well as the subrogation claim, may have to be paid from that settlement.
A good attorney will address the issue of subrogation with your employer provided plan before a settlement or verdict occurs. Negotiations over that subrogation claim prior to settlement will help you maximize your recovery. Therefore, it is of the utmost importance that you hire a lawyer who understands subrogation, and the consequences, defenses and techniques that may defeat or minimize your claim.
Contact Our Injury Attorneys For A Free Consultation
As you can see, the legal issues dealing with subrogation rights of employer-funded health plans are extremely complex. Therefore, it is extremely important that you hire a law firm with a full understanding of these issues.
At the Quinn Law Firm, we have lawyers who possess the skill, knowledge and experience to navigate these treacherous waters on your behalf. Contact our Erie injury attorneys today for a free consultation to discuss how we can help you protect your rights and get the most out of your injury case. Send us an email or call us at 814-806-2518 or toll-free at 866-641-8996 today.