ERISA Regulated Medical Insurance Coverage

If your medical insurance is regulated by ERISA (Employee Retirement Income Security Act), and a great many employer’s health insurance plans are, your insurer may demand that you reimburse them for your medical expenses according to contractual and/or ERISA rules and regulations.  Many HMO's and PPO's (e.g., Kaiser Permanente, Blue Shield, Western Health Advantage, Aetna, and Health Net to name but a few), are regulated by ERISA.

VERY IMPORTANT: Like Medi-Care and Medi-Cal, your attorney must be aware and understand the law and case decisions that regulate exactly what amount you are required to pay back your insurer pursuant to ERISA and contractual guidelines.  A competent attorney will help to reduce, and maybe eliminate, your reimbursement obligations.  A competent attorney can pay for himself by what he can save you in health insurance reimbursement requirements alone. 

It is vital your attorney is informed and on the cutting edge of this topic because laws, regulations, and court decisions alter insured’s reimbursement requirements frequently.  Yesterday’s rules on these issues may no longer be accurate.  If your attorney isn’t up on the latest developments, it can cost you plenty!

Worker's Compensation Plans. If you were involved in an accident while you were on the job, your employer’s workers’ compensation plan will extend benefits for your medical bills and loss of earnings. It is very important to speak with an attorney as soon as possible in these situations, as the coordination of your rights between your worker's compensation case and your personal injury case is essential.  Worker’s Compensation Plans also have a right to reimbursement which may greatly affect the amount of money available to you.

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Editor’s Note: This page has been updated for accuracy and relevancy [cha 11.14.19]

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