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HMO v. Provider Dispute

HMO underpaid the hospital for subscriber’s care. Hospital sued. Hospital said it was purely a state matter where as HMO said it was an ERISA matter. The court agreed with the hospital and remanded the case to state court.

Baylor University Medical Center v. Arkansas Blue Cross and Blue Shield, 32 EBC 2547 (N.D. Tex. 2004).

Retiree Health

Because the plan document had the right to amend reserved by the employer and because the plan document did not specify that the retiree benefits were vested, the employer had the legal right to terminate retiree benefits.

Vallone v. CAN Financial Corp., 33 EBC 1001 (7th Cir. 2004).

Discrimination by Health Status

The New York Insurance Law §4244(b)(2) forbids discrimination by health status. The court examined two meanings of this law:

  • 1.

    Discrimination between healthy and unhealthy.

  • 2.

    Discrimination between different subgroups of the unhealthy class (different

benefits for mental and for physical disorders, e.g.). The court said (1) is not proper; (2) is proper. Polan v. New York State Insurance Department, 33 EBC 1015 (N.Y. Ct. App. 2004).

Preemption

Employer was fraudulently induced to establish a plan and trust. The aggrieved employer sought redress as an ERISA matter. The court said no; the relief sought by the employer was a state, not an ERISA, issue.

Ram Technical Services v. Koresko, 33 EBC 1090 (D. Ore. 2004).

Venue

In a matter involving diversity, the court had to decide on venue. In doing so, it contemplated these factors:

  • Convenience of trial witnesses

  • Ability to compel unwilling witnesses

  • Convenience of plaintiffs and defendants

  • Locality of operative facts

  • Budget needs of the court and interested parties.

© 2004 International Foundation of Employee Benefit Plans, Inc. All rights reserved.

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