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98% Health Plan Recovery Settlement on Client’s Commercial Liability Fall Case
Client Focused. Results Driven.
Overview
Client: Fortune 25 ERISA Health Plan
Results: 98% Health Plan Recovery Settlement for Our Client’s Health Plan
The Challenge
Health Plan Recovery Settlement. In October 2011, an employee working for one of our larger ‘fully self-funded’ ERISA Plans was severely injured in a fall involving a commercial glass company. While this employee did end up terminating his employment, the Plan paid a total of $281,448.93 towards his injuries incurred as a result of the fall while he was covered by the Plan. By April 2014, counsel for the employee settled with the commercial glass company in the amount of $4.2 million and requested a significant reduction in the lien, claiming that his client would not be able to work in the future. Our client denied a lien reduction.
Million in Actual Cash Recoveries
The Approach
Using legal precedents, Vengroff Williams sent a denial of the lien reduction request to the attorney due to the Plan Document language which specifically prohibited reductions based on equitable doctrines.
In May, 2014, the employee’s attorney referred the matter to a lien reduction attorney. Vengroff, Williams, immediately, (1) confirmed that the original attorney was holding and would continue to hold the total amount of the lien in his client trust account, (2) demanded proof of the claim that the injured could not work in the future and, (3) continued to provide applicable legal precedents. We also requested permission from the Plan to file suit in federal court for distribution of the Plan’s lien. Said permission was granted.
Armed with the knowledge that the money was safe in the trust account and with permission to file suit, we continued to engage in a dialogue with the lien counsel, demanding proof of the permanency of the injuries. Lien counsel failed to provide any hard data and continued to offer multiple low amounts for the repayment of the lien. All were rejected and by December 2014, suit was filed in federal court against the former employee and Plaintiff’s Counsel.
Just as the employee and lien attorney were being served, and after thorough investigation it was determined that the employee was still able to work but only in a less demanding job. Armed with this new information, Vengroff Williams counteroffered to accept $275,000 (only a difference of $6,448.93 from the full lien) and agreed not to seek fees under ERISA for frivolous suit against the lien attorney. To this, the employee and lien attorney agreed on settlement of this case.
The Results
Vengroff Williams defeated arguments presented by the plaintiff’s attorney and an outside lien resolution attorney using the present state of the law combined with our continuing investigations into the underlying status of the injured party. Vengroff Williams’s expertise and continued follow-up led to a 98% recovery for our client’s health plan. Contact Us
