Wisconsin Court Green Lights Subrogation Action

January 29, 2003 (PLANSPONSOR.com) - A Wisconsin appeals court has upheld a decision by a trial court that a self-funded group health plan can try to recover benefits paid to a worker who later recovered that sum and more in damages.

The decision affirmed the ability of the health plan to recover the $36,000 in benefits it paid to the plaintiff who was injured in a car crash and later won $101,000 in damages.

The appeals judges ruled that the Associates Health and Welfare Plan subrogation claim didn’t have to be reduced under two state laws modifying damage awards because the plan expressly said in its summary plan description that the two laws didn’t apply. The plan covers Wal-Mart employees.

The judges also said a 2002 US Supreme Court decision that might have also limited the plan’s subrogation recovery didn’t apply because the plan sought repayment under Wisconsin state laws while the US high court case dealt with ERISA claims under federal law.

The case is  Palmerton v. Associates’ Health and Welfare Plan , 2003 Wisc.App. LEXIS 9, Wis. Ct. App. 2003.