Thursday, February 26, 2009


Posted by Sylvius Von Saucken

During a recent CLE I attended, I noticed that Anthem was referred to several times during your presentation and I wanted to know whether there are special concerns when dealing with Anthem that should be taken into account?

-Georgia Attorney

We referenced Anthem as a good example of a large health insurance company that we would expect would have similar “locked-in” plan language as did Wal-Mart (e.g. that the specific fund doctrine applies because they can recover specifically from the settlement/award, but only up to the amount of medical expenses.) We would expect Anthem to stay on top of all subsequent changes to ERISA through common (case) law because they have hundreds of firms on their payroll to make sure they have the most recent language. Even so, we would ask for Anthem Summary Plan Descriptions, plan language and Forms 5500, with all schedules attached, and look on to gather as much information as we could to ensure that the language grants the carrier the rights their subrogation agents say it does. (DON’T TAKE THEIR WORD FOR IT!)