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.

 Return to Personal Injury FAQs
Client Reviews
  • Me and my wife; had a car accident. We were amazed how easy, professional, friendly attorney Ed Smith is along with his staff. Everybody is amazing. Thank you so much, we are very impressed!
    Sincerely, Alex & Dinah M. ★★★★★
  • Ed Smith and his office team took on a difficult personal injury case on my behalf and for the passenger in my car. Ed is a top- notch attorney. His staff couldn't have been more helpful and kind. No need to look elsewhere. I give Ed Smith my highest recommendation. Beverly ★★★★★
  • Ed and Robert have been taking great care of my husband and I for the past 5+ years. They are always there when you have a problem and a quick resolution! Even when the issues have nothing to do with them. They are willing to help ease the pain off your shoulders. They are as good as it gets! Thank you again for everything. Annie T. ★★★★★
  • Very professional. Great team, staff and service all around. Mr Smith was very honest, straight forward with his advice. He gives the word "attorney" an honest reputation. I will seek his council anytime, and would recommend him at the drop of a dime. Jeremy M. ★★★★★
  • I would highly recommend Ed Smith to any friends or family in need of a personal injury attorney. Ed, and his staff, are very caring on top of being very experienced in this field. The staff always keeps you informed of the status of your case and they are always easy to reach by phone. Shannon D. ★★★★★
  • Edward Smith law offices provide competent, thorough, and personable help for victims of personal injury. When you first meet the staff you know you contacted the right office. This law office treats clients like people. I recommend this office to anyone seeking representation regarding personal injury. David M. ★★★★★