ERISA plan’s reimbursement rights

Posted by Matthew Garretson

Question:
Which plan document governs an ERISA plan's subrogation/reimbursement rights: The plan documents in effect at the time of the beneficiary's injury, the plan documents in effect at the time each health benefit is paid for treatment of the injury, the time of the settlement of the beneficiary's liability claim, the time the beneficiary receives settlement payments (for example structured settlement payments) or some other date? I've seen where the Pa. Supreme Ct. held that a plan's subrogation rights are determined at the time the benefit payment is made (Wilmer v. PEBTF, 939 A2d 843 (Pa. 2007)), but I've also seen general references to the time of injury as the determinative date.

-Georgia Attorney

Answer:
In our experience, it is the plan in force at the time of the injury through the treatment in question. Please let us know if we can be of any further assistance.

-Matt Garretson