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

"I have used Synergy to resolve tough Medicare lien and set aside issues. There is no other practice that comes close to the quality of their work. I highly recommend them and they are a must for the substantial, tough cases."

Mark R. Hanson
LaBovick Law Group

I wanted to pass my highest recommendation to Synergy who we routinely get involved in cases when Medicare issues come up, especially when dealing with Medicare Set Asides. Synergy went beyond the call of duty in a recent case that was settled and dealt one-on-one with our clients and their family. They spent time on the phone with them to be sure they got all their questions answered and did a fantastic job dealing with Medicare.

J. Daniel Clark
Clark Martino, P.A.

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