Forum
U.S. Supreme Court
Case Status
Decided
Docket Number
Term
2005 Term
Oral Argument Date
March 28, 2006
Questions Presented
As the Court of Appeals recognized below, this case presents a question that is the subject of a four-to-two circuit conflict and that was addressed but left open by the Supreme Court in Great-West Life & Annuity Ins. Co. v. Knudson, 534 U.S. 204 (2002). As the federal government has noted, the question is of extreme national importance and likely affects over $1 billion annually.
The question presented is:
Can a plan fiduciary bring a civil action against a plan participant to obtain “appropriate equitable relief” under Section 502(a)(3) of the Employee Retirement Income Security Act of 1974, 29 U.S.C. § 1132(a)(3), where a term of the plan requires the participant to reimburse medical expenses advanced by the plan if the participant recovers money from a third-party tortfeasor and possesses such payments in an identifiable fund?
Case Updates
Outcome
May 15, 2006
The Supreme Court affirmed the Fourth Circuit decision.
U.S. Chamber files amicus brief addressing ERISA and right to recover financial payments
February 23, 2006
NCLC has asked the U.S. Supreme Court to affirm an appellate court ruling that gives third-party healthcare fiduciaries the right to recover payments made to health plan beneficiaries based on Employee Retirement Income Security Act (ERISA) provisions. In this case, the healthcare provider, a subsidiary of UnitedHealth, paid $75,000 in medical claims for the Sereboffs, who were injured in an auto accident and later recovered $750,000 in personal injury claims in California courts. In its brief, NCLC noted that the Fourth Circuit held that a plan fiduciary may seek, under ERISA, equitable restitution and impose a trust or equitable lien on a portion of settlement funds that are within possession and control of the participant. If this decision is overturned, many employers might choose to stop providing health plans or require greater cost sharing with employees because of the higher costs associated with this type of litigation.