How to Stay Compliant When Resolving Complicated ERISA Liens
ERISA lien resolutions can be extremely complicated as not every private employee health plan is built the same. As a practice that focuses on providing the very best in personal injury law, sometimes ERISA liens surface that must be managed with utmost care and speed—even if it’s not your core business function. When faced with a complex lien, keep these factors in mind to achieve optimal outcomes:
Understand Plan Language
Successful ERISA lien negotiation starts with a clear understanding of the plan language in question. Plan language will ultimately determine whether reimbursement is required for an ERISA plan and to what magnitude. Make sure to fully comprehend plan details, including right of reimbursement and whether equitable defenses are permissible or subject to rejection.
Determine Funding Arrangements
Self-funded or insured? Sometimes it is not easy to establish the funding arrangements for an ERISA plan, but it is an essential detail in the final determination of a lien. In a self-funded plan (also known as a fully-insured plan), the employer funds both the plan and any employee health care expense payments with its own money. Federal laws apply to self-funded plans and associated reimbursement provisions can be enforced. In the case of an insured plan, the insurance company pays the health care expense payments and applicable state mandates apply to employee benefit plans and ERISA liens.
Request Plan Documents
A plan administrator or sponsor has a statutory responsibility to provide detailed plan documents within 30 days of a request associated with a potential ERISA lien. Make sure to inquire about, or have your assigned counsel petition for, plan details as they are necessary when optimizing recovery opportunities for your clients.
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Disclaimer: The information contained in this article is for general educational information only. This information does not constitute legal advice, is not intended to constitute legal advice, nor should it be relied upon as legal advice for your specific factual pattern or situation.