Category Archives: Uncategorized

Liability Medicare Set-Aside (MSA) Case Studies: Eliminate, Reduce & Comply

B. Josh Pettingill There is mounting evidence that the Centers for Medicare and Medicaid Services (CMS) will establish formal guidelines for liability MSAs in the imminent future.  Medicare Secondary Payor compliance related to future medical care is an issue that can’t be ignored but that doesn’t necessarily mean setting up a Medicare Set-Aside on every…

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From Roger Baron: SDNY holds SPD provision not enforceable under Cigna v Amara

Reprinted with permission from Roger Baron

In Durham v. Prudential Insurance, 2012 WL 3893604 (S.D.N.Y. Aug. 28, 2012), the Court was requested by the ERISA Insurer to uphold the “discretionary clause”  of the SPD, but the plan document did not contain a “discretionary clause.”  This Court applied the Supreme Court’s ruling in Cigna v. Amara and held that “the SPD cannot confer discretion.

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