Health and Disability Insurance
MH’s health and disability insurance practice team represents national insurers, as well as HMOs, managed care organizations, and Medicare Advantage Organizations, on a wide variety of matters in federal and state courts and arbitrations nationwide. We have extensive experience handling disputes involving coverage; ERISA; state insurance law claims including bad faith, prompt pay and deceptive or unfair practices; stop loss coverage for self-funded plans; fraud and rescission; Medicaid managed care; Medicare Advantage plans; recovery of overpayment; discount networks; and subrogation and reimbursement.
MH defends health insurers and claims administrators in multi-million dollar disputes brought by health care providers before arbitration panels and federal courts seeking to recover payment for services rendered. MH attorneys manage these cases efficiently and aggressively, handling a high volume of claims with varied coverage issues by using the depth and breadth of their experience to filter through thousands of claims, address threshold issues, and obtain favorable results for our clients. MH also pursues actions to recover overpayments made to providers on behalf of their clients.
With significant experience handling health care coverage disputes, MH attorneys also represent stop loss carriers across the nation providing excess loss coverage for self-funded health benefit plans. Our team understands the unique issues that are presented in stop loss coverage disputes, including the dynamic among and between stop loss carriers, third party administrators, brokers, and employer groups. MH has a track record for resolving such disputes pre-litigation, but also obtains favorable results through litigation and arbitration nationwide.
SUBROGATION AND RIGHT OF REIMBURSMENT
MH attorneys negotiate on behalf of insurance carriers, claims administrators, and self-funded plans to maximize recovery of reimbursement as to third party recoveries obtained by insureds, participants, and beneficiaries. This practice, which is on a nation-wide scale, requires application of experience and expertise in ERISA and state laws pertaining to subrogation and/or reimbursement and our team is uniquely equipped to handle a high volume of cases with minimal costs. While the vast majority of these matters result in recoveries outside of the courtroom, MH attorneys vigorously litigate subrogation or reimbursement rights when necessary, whether in civil litigation, workers’ compensation matters, or probate proceedings.
The ERISA landscape is ever-changing and MH attorneys are cognizant of the risks such changes pose to their clients. By remaining current on the developments and status of the law on a nationwide basis, MH is equipped to handle ERISA disputes anywhere in the United States. With decades of experience reviewing, analyzing, and defending ERISA benefit decisions, including decisions regarding life, accidental death and dismemberment, long- and short-term disability, and other welfare benefits, MH attorneys are prepared to assist clients with any aspect of their ERISA business, including DOL investigations, audits, consulting, and litigation. Working in tandem with their clients, MH attorneys regularly develop unique and novel strategies to solve complex problems while providing cost-effective representation on a case-by-case basis. Our ERISA team has successfully defended clients in class action suits, complex matters alleging breaches of fiduciary duties, and litigation related to health, welfare, and pension benefits before various federal trial and appellate courts. We represent plan sponsors, fiduciaries, administrators, carriers, and others involved in employee benefit plan and plan asset administration.