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A Self-Funded Employer's Worst Nightmare
Leonard, Street and Deinard
May 13, 2013 "The employer changed to a self-funded plan and purchased stop-loss that provided coverage for member claims that exceeded $75,000 up to a $1 million lifetime maximum. The employer thought that the health plan imposed a $1 million lifetime maximum on benefits.... [When the employer found itself responsible for payment of a claim that exceeded that maximum,] the employer argued that the agents had a special relationship with the employer in the design of the plan and the stop-loss coverage.... [T]he court refused to dismiss that claim. Thus, the employer will have the opportunity to show the court that there was a fiduciary relationship between the insurance agents and the employer and that the insurance agents should cover the losses not covered by the stop-loss insurance." MORE >> |
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