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Back and Neck Injury Claim Headed for US Supreme Court

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Washington, DCA plaintiff who suffered a back and neck injury at the hands of a drunk driver and spent most of his neck injury compensation money on legal fees and care for himself and his young daughter has successfully petitioned to have the US Supreme Court decide if he needs to pay back more than $120,000 to his benefits plan.

According to court documents, Robert Montanile suffered a serious back and neck injury when the car in which he was driving was hit by a drunk driver in Florida, in 2008. The other driver had run a stop sign. Montanile, who required lumbar spinal fusion surgery following the accident, launched a back injury lawsuit against the driver and won $500,000 in his back injury compensation claim - a claim that also included the injury to his neck.

Montanile’s benefits plan, the National Elevator Industry Health Benefit Plan (NEI), was successful in persuading a lower court to require Montanile to repay more than $120,000 in funds the Plan disbursed for medical expenses following the accident.

The actual amount at stake is $121.044.02. Health plans benefit from a reimbursement provision under ERISA that suggests a Plan having disbursed funds for medical care gets first dibs of any settlement money. Montanile had attempted to negotiate with the NEI. When those negotiations were unsuccessful, the Board of Trustees for NEI pursued the reimbursement in court and secured a favorable finding by a district judge. Montanile appealed, but the Eleventh Circuit upheld the judge’s original finding this past November.

In taking the case to the US Supreme Court, Montanile is citing a split in circuit court decisions with regard to reimbursement. Out of eight back injury lawsuits where plaintiffs had exhausted their settlement money, six circuit courts held that an insurer has a right to reimbursement, and to assert an equitable lien regardless of the surviving settlement funds. However, two courts have ruled against. In other words, an insurer cannot claim reimbursement of that which no longer exists. Provided a plaintiff has exhausted settlement money on necessary personal care and medical expenses, there is no requirement to reimburse.

Based on the split, the US Supreme Court, at the end of March, agreed to hear the case. The insurer in the back and neck injury case also supports and welcomes the involvement of the US Supreme Court. “Though the Eleventh Circuit’s holding is manifestly correct,” attorneys for the NEI Board of Trustees said in a statement, “the contrary rule lingering in other circuits creates uncertainty that harms plans and beneficiaries alike.”

The case is Robert Montanile v. Board of Trustees of the National Elevator Industry Health Benefit Plan, case number 14-723, in the Supreme Court of the United States.

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