Monthly Archives: March, 2012

From Roger Baron: 4th Circuit upholds Ahlborn over contrary North Carolina law

Reprinted with Permission from Roger Baron

“The 4th Circuit Court of Appeals handed down E.M.A. v. Cansler, 2012 WL 956187, yesterday. This decision holds that North Carolina law, “as applied in this case, fail[s] to comply with federal Medicaid law as interpreted by the Supreme Court in Ahlborn. As the unanimous Ahlborn Court’s decision makes clear, federal Medicaid law limits a state’s recovery to settlement proceeds that are shown to be properly allocable to past medical expenses.’ “

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US Airways v. McCutchen – Equitable Defenses Limit ERISA’s “Appropriate Equitable Relief”

Although most litigation has centered on what qualifies as “appropriate equitable relief,”  the U.S. Court of Appeals for the Third Circuit in US Airways, Inc. v. McCutchen, 663 F.3d 671 (3d Cir. Pa. 2011), addressed whether such relief is limited by certain equitable defenses. While the Third Circuit’s approach may be considered novel (at least until adopted by other courts), it presently allows equitable principles to override express plan language when justified by the necessities of the particular case. For attorneys in other jurisdictions representing severely injured beneficiaries against self-funded ERISA liens with strong plan language, referencing the Third Circuit’s logic may prove beneficial.

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From Roger Baron: Nevada Supreme Court Authorizes Tort Claim against ERISA entities

Reprinted with permission from Roger Baron

“Yesterday the Nevada Supreme Court handed down its decision in Lynam v Health Plan of Nevada, No. 56165 (March 21, 2012). The Nevada Supreme Court holds that ERISA preemption does not extend to “traditional police powers of the state” and makes a distinction between an ERISA plan which “facilitate[s] the selection of providers” and an ERISA plans which “lease[s] out its existing network of providers” or which “purchase[s] an insurance plan from a MCO or HMO.”  The insured should be given the opportunity on remand to prove that “to prove that [the health plan] merely leased out their network providers or issued an insurance policy” and thereby avoid federal preemption.”

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