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