Complicated ERISA Liens

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.

For more information or to schedule a consultation, please submit our contact request form or call (877) 242-0022.

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.

TESTIMONIALS

Thank you so much for the services your firm provided to our client. Should the need arise again, we will ALWAYS use Synergy. Your customer service was outstanding and the guidance and instructions your office gave us with our client's Medicare waiver application was instrumental in getting a FULL waiver of his Medicare lien. I know our clients were very grateful for your help, too. And, I just wanted to write and let you know how happy we were with your services. We will always recommend your company to any other plaintiff's attorneys that need help with lien reduction or waivers. Thank you again!

Peggy Rothenberger, Legal Assistant to Henry Moore
Law Offices of Henry Moore

"Synergy is an invaluable partner in the mediation process. They have extensive expertise in Medicare, Medicaid and Structured Settlements and the ability to explain the impact of these complex concepts to my clients in simple, clear and understandable language. This allows me to focus on obtaining the best possible result in the settlement process."

Michael J. Winer, Esq.
President Florida Workers Advocates (FWA)

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