CALIFORNIA HEALTH LIEN SUBROGATION RIGHTS: I just found out that my employer sponsored health plan is protected by a federal law known as ERISA , can my health plan subrogate or get paid back from my personal injury funds when I settle my California personal injury case?

Yes, it can!  ERISA protected health plans are tricky and you need an experienced California injury lawyer to help you - you can call me directly at (619) 813-7955.

Here is some of the California law (federal law which applies to California) on this FAQ:

Sereboff v. Mid Atlantic Medical Services, Inc. 126 S. Ct. 1869, 547 U.S. 356 (2006) ERISA plan may enforce a subrogation or reimbursement provision through an action for constructive trust or equitable lien against a plan participant holding settlement funds. The Ct distinguished its 2002 ruling in Knudson, supra, on the basis that the ERISA plan there sued persons not holding the funds (which had been deposited in a Special Needs Trust). Also distinguished Knudson on the basis that instead of seeking to impose personal liability as in Knudson, the Sereboff action “sought its recovery through a constructive trust or equitable lien on a specifically Identified fund.” Id at 363. The Ct declined to decide the application of the "make whole" doctrine but suggested in dicta that said defense would not apply to an action for equitable lien. Ct did not address the common fund doctrine which had been applied by both lower courts because it was included in the reimbursement provision in the plan.

This case is inconsistent with all 9th Circuit precedent since 1994 holding that ERISA plans cannot enforce their contractual reimbursement provisions under ERISA because 29 USC 1132(a)(3) only allows plans to sue for "equitable relief to enforce the terms of the plan." Ct relies heavily on its 1914 decision in Barnes for the proposition that one promising to convey property to be recovered in the future becomes a constructive trustee “as soon as he recovers a title to the thing...” suggesting title argument.

Mark C. Blane is a San Diego Auto Accident Attorney, and the managing lawyer of the Law Offices of Mark C. Blane, a San Diego, California Personal Injury Law Firm devoted to representing families of injured persons of automobile accidents. If you or someone you love, has been injured or killed in San Diego County, or Southern California, due to the negligence of another, please order your FREE copy of Mr. Blane's book, The 10 Secrets You Need To Know About Your Injury Case, BEFORE You Call A Lawyer. It is full of helpful information, insights, and secrets that will help you protect your legal rights.  It normally sells for $16.95; however, it is free to all California residents, or those injured in a California accident.

 

 

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