The plan insurer then sued the participant to enforce its right of reimbursement found in the certificate of insurance, which had been signed by the participant as a condition of plan eligibility. The trial court awarded full reimbursement and attorneys' fees to the insurer. On this appeal, there were two substantive issues before the Sixth Circuit. In dealing with the first, the court rejected the participant's argument that characterization of the settlement as relating only to personal injuries precluded any reimbursement recovery.
State laws designed to limit or preclude subrogation and reimbursement are relatively common.
Nevertheless, there are a number of other restrictions that can apply to limit recovery by self-funded plans, depending in part on how a plan's subrogation or reimbursement provision is drafted. All rights reserved.