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ADMINISTRATIVE INVESTIGATIONS AND THE POTENTIAL LOSS OF THE ATTORNEY-CLIENT PRIVILEGE
Douglas A. Mang, Esq. Wendy Russell Wiener, Esq. Connie P. Crews, Esq. An insurer's counsel may be called upon to participate in an investigation conducted by a state or federal agency. Participation in the investigation can destroy the privileged nature of some communications between an insurer and its attorneys, both in-house and outside. In order to avoid such destruction, counsel must proceed carefully when "cooperating" with an agency investigation.
STATE REGULATION OF DOWNSTREAM RISK UNDER MANAGED CARE PLANS: CAN NEGOTIATED RULEMAKING WORK?
D. Michael Frink, Esq. Under Managed Care Health plans, a variety of health care provider organizations have entered into contractual arrangements with the plan to provide services to plan members. These provider organizations include physician hospital organizations, consolidated physician practice groups, and a wide variety of affiliated health care providers. Under some of these arrangements, the health care providers assume, directly or indirectly, substantial financial risk. The nature of the financial risk also varies greatly, including the acceptance of a predetermined monthly payment - a capitation - in exchange for agreeing to provide all reasonably necessary medical services required by plan members who are patients of the health care provider. The risk can also be a "back-end" risk-sharing arrangement, wherein the provided group receives interim payments from the plan or from self-insured employer groups, subject to a year-end reconciliation against a medical expense target. In these arrangements, the provider group can be placed "at-risk" for a "corridor," expressed as a maximum percentage amount in excess of the medical expense target that actual medical expenditures amount to for a given plan year. There are also per diem, global capitation, and a variety of other risk arrangements currently in place around the country.
RECIPROCAL CAPTIVE INSURANCE COMPANIES AS AUTHORIZED UNDER THE VERMONT CAPTIVE INSURANCE LAW
Jeffrey P. Johnson, Esq. In 1981, Vermont enacted legislation authorizing the formation of captive insurance companies. In its simplest form, a captive insurance company insures the risks of its parent corporation or association. The Vermont captive insurance law excludes all other portions of the insurance code, except for those sections specifically referenced in the captive statutes. This permits the operation of captive insurers under a regulatory scheme that is extremely flexible. However, the term flexible should not be equated to a lack of regulatory oversight.
DIRECT PROCUREMENT: STATE OF THE LAW
Frederick J. Pomerantz, Esq. The right of an insured to directly place coverage with an insurer of his choice is constitutionally protected, although a state may legitimately assess a tax on the transaction and require it to be reported. State Board of Insurance v. Todd Shipyards Corp., 370 U.S. 451 (1962); Connecticut General Life Insurance Co. v. Johnson, 303 U.S. 77 (1938); St. Louis Compress Co. v. Arkansas, 260 U.S. 346 (1922); Allgeyer v. Louisiana, 165 U.S. 578 (1897). Thus, constitutional protection has been codified by the insurance laws of nearly three-quarters of the states and the District of Columbia. In these jurisdictions direct procurement is explicitly recognized by statute. One state, Delaware, does not have a statute recognizing direct procurement; however, the right exists in case law. |
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