November 2004 - Lawson

<body topmargin=0 leftmargin=0 marginheight=0 marginwidth=0> <table cellpadding=0 cellspacing=0 border=0><tr> <td valign="top" colspan=2 height=90 BGCOLOR="#006699" TEXT="#080000" background="04a085a3.jpg"> <div> <FONT SIZE="5" COLOR="#FFFFFF" FACE="Arial" ><B>Kreiner & Peters Co., L.P.A.</B></FONT><B>    </B><B> |     </B><A HREF="index.htm" TARGET="_top" TITLE="Kreiner Peters Co., L.P.A."><U><B>home</B></U></A></div> <div> <A HREF="id46.htm" TARGET="_top" TITLE="December 2004 Subrogation under Legisla"><U>December 2004 - Subrogation under Legislative Scrutiny</U></A><B>   |   </B><B>November 2004 - Lawson</B><B>   |   </B><A HREF="id40.htm" TARGET="_top" TITLE="November 2004 Restitution"><U>November 2004 - Restitution</U></A><B>   |   </B><A HREF="id45.htm" TARGET="_top" TITLE="August 2004 Rental"><U>August 2004 -  Rental</U></A><B>   |   </B><A HREF="id37.htm" TARGET="_top" TITLE="February 2002 ERISA"><U>February 2002 - ERISA</U></A><B>   |   </B><A HREF="id36.htm" TARGET="_top" TITLE="November 2001 ERISA"><U>November 2001 - ERISA</U></A><B>   |   </B><A HREF="id35.htm" TARGET="_top" TITLE="November 2001 Evidence"><U>November 2001 - Evidence</U></A><B>   |   </B><A HREF="id34.htm" TARGET="_top" TITLE="June 2001 Intentional Acts"><U>June 2001 - Intentional Acts</U></A><B>   |   </B><A HREF="id33.htm" TARGET="_top" TITLE="May 2001 Fiduciary"><U>May 2001 - Fiduciary</U></A><B>   |   </B><A HREF="id32.htm" TARGET="_top" TITLE="April 2001 ERISA provisions"><U>April 2001 - ERISA  provisions</U></A><B>   |   </B><A HREF="id31.htm" TARGET="_top" TITLE="January 2001 ERISA"><U>January 2001- ERISA</U></A><B>   |   </B><A HREF="id30.htm" TARGET="_top" TITLE="2000 ERISA Fiduciary"><U>2000 - ERISA Fiduciary</U></A><B>   |   </B><A HREF="id29.htm" TARGET="_top" TITLE="2000 Medical Payments"><U>2000 - Medical Payments</U></A><B>   |   </B><A HREF="id28.htm" TARGET="_top" TITLE="2000 ERISA"><U>2000 - ERISA</U></A></div> <div> </div> </td> </tr><tr> <td valign="top" width=210 BGCOLOR="#FFFFFF" TEXT="#080000" background="04bd2e83.jpg"> <bR> </td> <td valign="top" height=390 BGCOLOR="#FFFFFF" TEXT="#080000"> <div> <I>November 2004 - Lawson</I></div> <bR> <div> <B>NOVEMBER 2004</B></div> <bR> <div> <B>NOT AGAINST PUBLIC POLICY TO WRITE OUT MADE WHOLE DOCTRINE IN OHIO</B></div> <bR> <div>      By a 4-3 decision, the Ohio Supreme Court has held that it does not violate public policy for a provider of health benefits to enforce a clear and unambiguous reimbursement provision against an insured, regardless of whether the insured was made whole.  See <U>Northern Buckeye Education Council Grp. Health Benefits Plan v. Lawson</U> (2004) 103 Ohio St. 3d 188.  </div> <bR> <div>      In <U>Lawson</U>, the Northern Buckeye benefit plan paid $85,945.37 in medical expenses related to a motor vehicle accident after Lawson signed a separate subrogation and reimbursement agreement.  After recovering $100,000.00 from the tortfeasor's carrier and $150,000.00 from her own underinsured motorist carrier, Lawson refused to reimburse the plan arguing that she was not made whole by her recovery.  The Ohio Supreme Court followed Federal Court precedent out of the Sixth Circuit Court of Appeals and held that a reimbursement provision that establishes both (1) that the insurer has a right to recover when there is a full or partial recovery and (2) that the insurer has priority over its insured, is an unambiguous and enforceable contract.</div> <div>      </div> <div>      In doing so, the Court maintained Ohio's long held precedent of enforcing contracts as they are written.  “Cases of contractual interpretation should not be decided on the basis of what is just or equitable.  This concept is applicable even where a party has made a bad bargain, contracted away all his rights, and has been left in the position of doing the work while another may benefit from the work.”  <U>Lawson</U>, 103 Ohio St. 3d 188.</div> <bR> <div>      It remains to be seen whether courts will enforce reimbursement provisions which are not identical or strikingly similar to the language used in the <U>Lawson</U> benefit plan.  Many health and accident plans had already amended their language to ensure that it was unambiguous based upon prior decisions out of the Federal Courts.  Property and Casualty carriers should review the subrogation and reimbursement provisions in their policies (i.e. medical payments coverage) or separate subrogation and reimbursement agreements to ensure that they are unambiguous and enforceable.</div> <bR> </td> </tr></table></body>