Source: https://www.blanelaw.com/library/list-of-67-important-cases-re-liens-cases-812-san-diego-injury-law-firm.cfm
Timestamp: 2019-04-19 02:40:13+00:00

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Insurance company's claim for reimbursement under a group health plan governed by ERISA is preempted. State courts have no jurisdiction over such claims.
The court here held that under a state Medicaid program funded by federal Medicaid funds, a hospital or other provider was barred from accepting state Medicaid benefits and then pursuing the patient for the balance over the amount paid by Medicaid. The court expressly held that if there is a windfall created by this situation, that windfall was intended to go to the personal injury victim and not the medical provider.
10. Mercy Hospital and Medical Center v. Farmers Insurance Group, 15 Cal.4th 213 (1997) The Court here held that a hospital lien claimant could not recover more than 50% of the gross recovery under the available policy limits from the tortfeasor's insurance carrier despite the fact that said carrier had paid its policy limits without honoring the lien. The Court also noted that the hospital's lien rights were not exclusive.
Circuit would not recognize a claim of unjust enrichment in these circumstances under the law of ERISA.
The Ninth Circuit here held that an insurance carrier's claim for reimbursement from its insured's personal injury recovery was a contract claim for damages not allowable under ERISA (29 USC §1132(a)(3)). The court held that to qualify as equitable relief under §1132(a)(3), restitution would require that the claimant has obtained the payments from the plan through fraud or other misconduct. The court suggested in footnote 2 that the carrier can sue for this relief in state court, which would likely violate the rule of complete preemption and exclusive federal jurisdiction previously adopted by the Supreme Court in Pilot Life v. Dedeaux, 107 S.Ct. 1549 (1987) and Metropolitan Life v. Taylor, 107 S.Ct. 1542 (1987). See also Bast v. Prudential.
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