Court decision may affect health plan reimbursement provisions

Description

Abstract: Historically, plan sponsors and administrators have come to rely on an ERISA provision for full reimbursement of medical expenses paid to participants if the plan document contains specific language to this effect and injured participants recover money from third parties. However, the U.S. Court of Appeals for the Third Circuit recently refused to enforce such a provision. In making this decision, the court significantly departed from existing case law. This article summarizes the case and how it may affect plan reimbursement provisions. Citation: US Airways, Inc. v. McCutchen, 663 F.3d 671 (3d Cir. Nov. 16, 2011); 29 USC 1132(a)(3).