QLG Obtains Court Ruling: Health Insurers Can Be "Fired" By The Court From Handling Claims

ERISA has a 40-year history in the courts as to how health plan claims should be handled and what the role of an insurer or health plan administrator should be when handling patients’ claims for reimbursement. One important legal concept is that health insurers and administrators of health plans are “fiduciaries” under ERISA. That requires the insurers and administrators to act in the best interests of the employees, their dependents, and other beneficiaries under health plans. We contend that medical providers are indeed “beneficiaries”, as a number of courts have concluded. Therefore, the health insurers and administrators must not refuse to handle their responsibilities under ERISA when dealing with medical providers. This concept is not typically pursued, pressed, or enforced by health care lawyers who are unfamiliar with ERISA.

However, at Quadrino Law Group, we know that the health insurers and administrators are fiduciaries; but what about their employees? In a case in federal court in Louisiana, we recently obtained a decision that even the employees of health insurers or administrators who violate ERISA can be removed from their jobs; i.e. removed as fiduciaries.

We used a section of the ERISA law that allows a court to take this removal action if a fiduciary “breaches any of the responsibilities, obligations, or duties imposed upon fiduciaries” under the ERISA law. In the Louisiana case, we not only sued a Blue Cross Blue Shield entity, but two of its employees who persistently engaged in a pattern of ignoring all of their responsibilities under ERISA. The federal court refused to dismiss the lawsuit against these two employees, ruling that the case against them, seeking their removal, would proceed.

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