ERISA Preemption, Remedies for Denied Or Delayed Health Claims PDF Download
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Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
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ISBN:
Category : Business & Economics
Languages : en
Pages : 56
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Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 56
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Author:
Publisher:
ISBN:
Category :
Languages : en
Pages :
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Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
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ISBN:
Category : Health insurance claims
Languages : en
Pages : 47
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Author: United States. Congress. Senate. Committee on Appropriations. Subcommittee on Departments of Labor, Health and Human Services, Education, and Related Agencies
Publisher:
ISBN:
Category : Health insurance claims
Languages : en
Pages : 47
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Author: Katherine Traverse Vukadin
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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This article advocates a shift in thinking in the enforcement of claims processing regulations. Under the current approach, most non-compliance is excused under the “substantial compliance” doctrine, and even substantial departures from the claims regulations generally result in no substantive remedy. This approach excuses practically all instances of regulatory non-compliance and places the enforcement burden on those least able to shoulder it -- the individuals seeking and paying for medical care. Instead, ERISA's goal of ensuring contracted benefits would be better served if enforcement moved to a presumed-harm approach, akin to the approach used in numerous consumer finance laws. This article argues that the same concerns driving consumer financial protections have even greater force where healthcare is concerned.
Author: Lorraine A. Schmall
Publisher:
ISBN:
Category :
Languages : en
Pages : 0
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The dissatisfaction with the Court's broad interpretation of the preemption provisions of ERISA, without specifically articulating what remedies existed to replace preempted state remedies, has been often brought to the attention of Congress by those who believed that the Court's construction of the preemption provisions of ERISA, without a recognition of some rights and remedies to take the place of preempted state rights and remedies, went beyond what the Congress intended. But the Supreme Court may never have intended for ERISA to preempt health care claims in most instances, and recently reiterated: "in the field of health care, a subject of traditional state regulation, there is no ERISA preemption without clear manifestation of congressional purpose." Federal and state courts have followed that lead by finding ways for state laws to protect their citizens. Apparently, there is a medical malpractice crisis which is caused by too much malpractice by doctors, too greedy plaintiffs, or unwarranted but uncontrolled insurance premiums. But this paper is concerned with how patients who have suffered from poor or inadequate medical care can seek redress. Health care costs continue to skyrocket, and one of the concomitants of cost containment is the creation of legal hurdles for patients who have been injured by a failure to provide, or negligent provision of, health care. Since most health insurance is tied to employment, ERISA, the federal law that regulates all employee benefit plans, including health insurance, complicates patients' medical malpractice claims. Many federal courts have concluded that if the quality or denial of care is considered part of the administration an employee benefit plan, all state actions may be preempted. If an employee wants to bring a claim against the physician or the managed health care organization, the employee must consider whether the claim will fall under state law, or whether the state cause of action will be preempted by ERISA. Because state law may offer employees greater protections than ERISA, broad federal preemption of state law under ERISA is also a part of the problem for an employee seeking protection against employer discharges and other acts that interfere with her rights to benefits. Rather than wait for Congress to amend a complicated tax and labor statute, plaintiffs can begin to look toward resolution in state common and statutory law.
Author: Katherine Traverse Vukadin
Publisher:
ISBN:
Category :
Languages : en
Pages : 34
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The Affordable Care Act (ACA) grew out of a longstanding desire to bring universal healthcare coverage to Americans. But universal healthcare was not the only goal. Some longed to see ERISA's preemption of state-law remedies softened, so that healthcare claims in ERISA plans could no longer be delayed and denied with impunity. While the ACA now extends coverage to more Americans, ERISA preemption remains unchanged. So, when ERISA healthcare plans -- which insure most Americans -- improperly delay or deny healthcare claims, the plans still risk nothing more than the eventual payment of that claim's value.This article posits that ERISA claims processing and preemption reform is the unfinished business of the ACA -- without it, the consumer remains consistently disadvantaged by both the process and substance of healthcare claims processing. Substantively, the ACA leaves ERISA preemption intact so that plan participants with denied claims must work tirelessly and with exacting attention to detail in order to appeal and eventually win back -- at most -- the value of the denied or delayed claim. Without further changes to the claims process and ultimately, to ERISA preemption, the ACA includes more people in health plans but also leaves them vulnerable to the vagaries of health plan decision-makers. The promise of universal, meaningful healthcare coverage therefore remains incomplete.
Author: United States. Congress. Senate. Committee on Labor and Human Resources. Subcommittee on Labor
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 136
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Author: James F. Jorden
Publisher: Aspen Publishers Online
ISBN: 073556311X
Category : Business & Economics
Languages : en
Pages : 1151
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Book Description
Handbook on ERISA Litigation cuts through complicated statutory provisions andtells you which ERISA claims are recognized by which courts and how tolitigate them.
Author: Richard Rosner
Publisher: CRC Press
ISBN: 1482262290
Category : Law
Languages : en
Pages : 1097
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Book Description
The third edition of this award-winning textbook has been revised and thoroughly updated. Building on the success of the previous editions, it continues to address the history and practice of forensic psychiatry, legal regulation of the practice of psychiatry, forensic evaluation and treatment, psychiatry in relation to civil law, criminal law and family law, as well as correctional forensic psychiatry. New chapters address changes in the assessment and treatment of aggression and violence as well as psychological and neuroimaging assessments.
