Wilson v. Group Hospitalization and Medical Services, Inc., 15 EBC 1446, 1992 WL 96206 (Westlaw)(D.D.C. 1992)

Article Abstract:

The District Court of Columbia ordered Blue Cross Assn to provide coverage for Deborah Wilson's chemotherapy treatment since they failed to provide timely and effective notice of their health plan amendment. Blue Cross Assn refused to grant certification payment to Wilson based on a Nov 30, 1991 amendment to the health plan regarding organ transplants. The district court, however, Blue Cross Assn did not give Wilson's employer sufficient notice to the plan amendment. Moreover, the court ordered the isurance carrier to continue coverage of Wilson's medical and recovery costs.

Accident and health insurance, Laws, regulations and rules, Health insurance, Blue Cross Association, United States. District Court. District of Columbia, Wilson, Deborah

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Offsetting liability for breach of fiduciary duty

Article Abstract:

The District Court of New Jersey held that under the antialienation provisions of the ERISA pension benefits cannot be used as a compensation for a fudiciary's criminal misuse of fund assets. The court ruled in the Coar versus Kazimir case that in the absence of specific instructions from Congress, ERISA's antialienation provision must be fully applied even if it meant honoring the pension benefits of an employee convicted for breach of fiduciary duty.

Pension, health, and welfare funds, Usage, Pension funds, Coar, Robert, United States. District Court. New Jersey

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Fiduciaries-HMOs-incentives to ration care

Article Abstract:

The Supreme Court ruled in Pegram v. Herdrich that a health maintenance organization is not liable for breach of fiduciary duty as a result of its doctors' mixed eligibility decisions. The case is further detailed.

Medical care, Herdrich, Cynthia, Pegram, Lori, Carle Clinic Association

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