MONTANILE V. BOARD OF TRUSTEES OF THE NA­TIONAL EL­E­VA­TOR IN­DUS­TRY HEALTH BEN­E­FIT PLAN

Modern Healthcare - - LEGAL -

This case hasn’t grabbed much at­ten­tion, but it presents some in­ter­est­ing is­sues that could af­fect in­sur­ers.

The case cen­ters on this ques­tion: If a plan’s ben­e­fi­ciary wins money in court for an in­jury but then spends it, should the ben­e­fi­ciary still have to re­im­burse his or her in­sur­ance plan for the med­i­cal ex­penses it paid?

The ben­e­fi­ciary in the case, Robert Montanile, ar­gues that forc­ing him to re­im­burse his in­surer for money he won for a car ac­ci­dent is un­fair be­cause he’s al­ready spent it on liv­ing ex­penses for him­self and his daugh­ter. His health in­sur­ance ad­min­is­tra­tor, how­ever, says that’s part of the deal, and al­low­ing ben­e­fi­cia­ries to skip such re­im­burse­ments could af­fect plan af­ford­abil­ity.

“Health plans rea­son­ably do not want to spend their lim­ited re­sources pay­ing med­i­cal bills that could, and should, have been paid by the ac­tual wrong­doer,” ac­cord­ing to a brief filed with the Supreme Court on be­half of the in­surer.

Plans make more than $1 bil­lion a year un­der such re­im­burse­ment pro­vi­sions, ac­cord­ing to the health plan.

But Berkowitz, whose firm also rep­re­sents Montanile, said if the Supreme Court sides with the in­surer, it could have a rip­ple ef­fect for many con­sumers.

The Supreme Court is sched­uled to hear oral ar­gu­ments in the case Nov. 9.

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