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Feb 11 2014

Multiemployer Health Plan Sought Reimbursement for Medical Expense Payments


The United States District Court for the Southern District of New York recently dismissed the claim of a multi-employer health fund for reimbursement of approximately $100,000 from a student accident insurance provider.  In Central States Southeast and Southwest Area Health & Welfare Fund v. Gerber Life Insurance Co., the Fund filed an action under ERISA claiming that Gerber had primary responsibility to pay certain accident-related claims on behalf of student athletes who were covered by a policy issued by Gerber and who were also covered by the Fund.  The Fund’s action relied upon a coordination of benefits (COB) provision in its Plan governing the proper procedure for payment of benefits for claims impacting multiple insurers.  Gerber claimed that it was secondary to the coverage provided by Central States because its policy provided only excess coverage and claimed that the Fund sought legal relief in the form of a monetary award rather than equitable relief provided for by ERISA Section 502(a)(3). The Court agreed with Gerber’s argument and granted Gerber’s motion to dismiss.  This action was similar to two other lawsuits filed by Central States in the Northern District of New Jersey in 2013 which were dismissed on the same grounds.

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