This case involves a man past retirement age who underwent an elective surgery and subsequently succumbed to a hospital-acquired infection. The patient accrued more than $1 million in medical expenses which had been fully covered under a self-funded plan. An actuarial expert familiar with The Employee Retirement Income Security Act and the Medical Injury Compensation Reform Act was sought to address how this self-funded plan differed from an insurance plan and how the $1 million dollars of expenditure could be considered damages.
Question(s) For Expert Witness
1. Please describe your background as an actuary.
2. Have you worked with ERISA?
3. In what ways could a self-funded health care plan differ from an insurance policy?
Expert Witness Response E-142736
I am a fellow of the society of actuaries, an enrolled actuary, and a member of the American academy of actuaries. I have worked with ERISA for over 40 years as a pension actuary. I am quite used to reading legislation and regulations and I have consulted on several cases regarding the loss of income. In this case, since the plaintiff's medical benefits were paid in full, there is little difference between a self-funded plan and an insurance policy, and the self-funded plan may well be more generous than an insurance policy. There may be tax ramifications of the $1 million payment, although I doubt it. Since the plaintiff was past retirement age, I doubt the lost earnings would amount to much. It sounds as if the most significant damages would be pain and suffering, as well as possible loss of consortium if the plaintiff were married.
About the author
Victoria Negron
Victoria Negron has extensive experience in journalism and thought leadership in the legal space, with a background crafting content, whitepapers, webinars, and current event articles pertaining to the role of expert witnesses in complex litigation matters. She is a skilled professional specializing in B2B product marketing and content marketing. Currently, she serves as an Enterprise Product Marketing Manager at Postman, and previously held the position of Technical Product Marketing Manager at Palantir Technologies, where she developed her skills in launch strategies, go-to-market strategy, and competitive analysis.
Her expertise in content marketing was further refined during her tenure at the Expert Institute, where she progressed from a Marketing Writer to Senior Content Marketing Manager, and eventually to Associate Director of Content & Product Marketing. In these roles, she honed her abilities in digital marketing, SEO, content strategy, and thought leadership.
Educationally, Victoria holds a Master of Business Administration from the University of Florida - Warrington College of Business and a Bachelor of Arts in Literature, Art, and Hispanic Studies from Hamilton College. Her diverse educational background and professional experience have equipped her with a robust skill set in product marketing, content development, and strategic marketing initiatives.
