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Mulvaney and Rose Obtain Dispositive Motion in Plaintiff’s 11th-Hour Theory of Entitlement to Benefits under ERISA

May 9, 2019

Kevin Mulvaney (Partner-Michigan) and Lauren Rose (Associate-Michigan) represented an automobile insurer sued on a balance bill in the case of a child severely injured in an automobile accident. The plaintiff, a medical provider, sued in Oakland County Circuit Court claiming the differential between what the health insurer paid and the balance of the bill. Essentially, the plaintiff sued on a balance bill, deciding at the 11th hour to argue a theory of entitlement to benefits under ERISA, arguing that because the health insurer was an ERISA plan, the plaintiff was somehow entitled to recoupment of the outstanding balance of the payment. Kevin and Lauren filed a motion for summary disposition to dismiss the case based on the balance bill argument and the ERISA theory. The plaintiff had argued that because the health insurer could potentially attempt to recoup the payments it made to plaintiff, if the underlying insured received a third-party settlement, the plaintiff should get money from the automobile insurer because they will have to pay this money in the future. When the plaintiff was forced to come up with an argument that aligned with ERISA, they used a hypothetical that did not apply to any of the facts of the instant case. The court agreed with Lauren’s argument and dismissed.

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