First party or third party?

[bowler87]

What is the name of your state? Nebraska

Erisa Health Plan policy provision:

"THIRD PART LIABILITY
When member is injured in auto accident member agrees to reimburse the Plan for the claims paid. This payment shall be made when DAMAGES are received from third party liability carrier."

I was hit my uninsured driver. I have UM coverage.

I have family auto policy with med-pay coverage.

This med-pay coverage is NOT subject to above policy provision, is it? The med-pay is first party benefits. The UM is third-party damages.

Plan states that the above provision allows them to intercept the benefits that are being sent to me by my individual insurance coverages.

I have accident insur that pays up to $1000.
I have med-pay insur that pays up to $2000.
I have accident disability that pays $500 month.

The Plan says they have a right to ALL of these benefits----
I say they have a right ONLY to my UM , and that will be paid only after the claim is settled.

If they do this to me, they must have been doing it to everyone .
I believe they are wrong.

Plan is in California---I am in Nebraska----accident in FLorida.

Can an ERISA Health Plan be subject to Punitive Damages?
I will file the suit in California.

 

[CIAA]

I am not an attorney and don't give legal advise, but based on what you have said, looks like only third party payments are recoverable.

ERISA plans are generally exempt for state common law. This is an interesting case because it doesnt' seem to involve a plan benefit determination. If their attempt to recoup is determined to be "arbitrary and capricious" they may be liable for damages, but if they don't recoup it seems difficult to determine what damages you were caused other that cost of defense.

Perhaps one of the attornies will advise us all further.