Archive for October 27th, 2009

Health Insurance Nightmare Resolved

What had turned out to be an ongoing nightmare is finally over for one satisfied Kamensky Cohen client. Several years ago our guy was involved in a horrific accident while riding his motorcycle. The driver of a car had made a right turn in front of him and, with no time react, the client struck the rear of the offending car. The injuries were so severe that a local police officer who had known the motorcyclist since grade school was unable to recognized him. Fortunately the motorcyclist’s team of doctors were not only able to save him, but had also save his right hand that was essentially amputated.

Recovery was long and difficult. There were multiple surgeries and months of painful physical therapy sessions. The treatments resulted in a substantial amount of medical bills, which, thankfully were covered by the client’s health insurance. However, that same health insurance carrier then put a lien on the client’s lawsuit’s recovery for damages to pay them back for the money they had paid to cover his medical bills! A lawsuit had been filed against the driver of the car that had caused the accident to recover for our client’s lost income and permanent loss of use of dominant hand that had been the result of the accident. If paid back to the health insurance carrier to compensate them for the money they paid out for his medical care, it would have left the client with little to compensate him for his permanent losses and lost income. Where is the justice in that! He had paid his health insurance premiums for years for just such a situation and the insurance carrier wanted to take back their costs for providing him with medical care from money he recovered in his lawsuit for damages!

The health carrier’s claim was based upon the federal act, commonly known as ERISA. ERISA or the Employee Retirement Income Security Act provides the health carrier with a legal right to seek recovery of the medical bills that it had a contractual obligation to pay. Since ERISA is a federal act, it supercedes New Jersey law that prohibits the health carrier’s attempt to collect the funds from our client. It was a tough case!

Kamensky Cohen took an aggressive approach against the health insurance carrier to identify the limited exceptions to ERISA’s preemptions of New Jersey law. Our efforts were finally successful. The resolution of the case eliminated  most of the health carrier’s lien against our client’s recovery. We had one truly relieved and satisfied client. Our reputation is our most important asset. We guard it with our clients’ satisfaction!