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.