In this particular case we represented a Self-Funded Benefit Plan, which had paid $140,000 in medical bills on behalf of the injured party. Of the $140,000, a reinsurance carrier had reimbursed the Plan $75,000.
The Phia Group received a call from the Plan advising that the reinsurance carrier had retained its own counsel to pursue the $75,000 it had paid. The Plan further explained that the reinsurance carrier’s attorney advised closing the file because the patient’s attorney had raised a made whole argument (third party funds were inadequate and failed to fully compensate the patient).
The patient was going to receive a $50,000 policy limit, which was significantly less than their losses. The Phia Group contacted the attorney to gather additional details and determined that the patient was not only receiving a $50,000 policy limit; they were also pursuing a $250,000 underinsured motorist claim. Upon receipt of this information we reviewed the Plan Document and applicable law regarding the Plan’s right to reimbursement. The Plan language expressed a clear right of reimbursement from underinsured motorist claims.
The Phia Group’s Third Party Liability Lawyers contacted the reinsurance carrier’s Third Party Recovery vendor and obtained permission to take the lead on this file. With permission to fully handle the file The Phia Group was able to negotiate with the attorney and secure a recovery for both the Plan and the reinsurance carrier.
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