Wal Mart stated the company had to look out for the overall members of the plan..in other words nothing in view of a tragic accident even matters at all...they just want their money...is the health plan in reality a "loan" and not full insurance? Health plan administered by United Health Care.....ERISA needs another look when things like this are happening...loopholes and interpretations are winning.....not the patient...BD
Can you imagine recovering a settlement after being permanently injured in a car accident that wasn’t your fault, and then being sued by your own health insurance plan to recover all of your settlement funds?
That’s exactly what happened to 52-year-old Missouri resident Deborah Shank. A collision with a semi-trailer truck seven years ago left Shank permanently brain-damaged and in a wheelchair. Her husband, Jim, and three sons found a small source of solace: a $700,000 accident settlement from the trucking company involved. After legal fees and other expenses, the remaining $417,000 was put in a special trust. It was to be used for Mrs. Shank's ongoing and future medical care.
But instead of using that money for her medical treatment, it will likely all go to repay Shank’s health insurance plan. The health plan was administered through Shank’s employer at the time – Wal-Mart Stores, Inc. Wal-Mart’s health plan was created under ERISA (Employee Retirement Income Security Act of 1974). ERISA is a federal law that sets minimum standards for most voluntarily established health plans in private industry to provide protection for individuals in these plans. Administrators of employer-financed health plans "have an obligation to participants to be impartial," the Wal-Mart spokeswoman says.
A Supreme Court ruling last year also has given them a stronger legal position to sue employees. And the employers have been winning. Her Wal-Mart ERISA health plan sued Shank to recover the $470,000 it spent on Shank’s healthcare. It did not matter that Shank only had $417,000 left over after payment of lawyer fees and litigation costs. In fact, Shank’s lawyer anticipated Wal-Mart’s lawsuit and tried to protect these funds by depositing them in a “special needs” trust. But the federal district court ruled that this special trust offered no protection, and it could not defeat the claim asserted by Shank’s ERISA plan.More from the Wall Street Journal here....