UnitedHealthcare to Face Post-Accident Benefit Clawback Claims

UnitedHealthcare Insurance Co. and subsidiary Optum Inc. must defend claims that they violated federal benefits law by recouping $25,000 in medical expenses from a health plan participant’s personal injury settlement.

The participant, who suffered injuries in a 2014 car accident, validly alleged violations of the Employee Retirement Income Security Act’s prohibited transaction and fiduciary duty rules, Judge J. Philip Calabrese said Thursday. The defendants are accused of using plan assets to fund “illegitimate collection efforts” for their own benefit and of providing misleading information about their ability to recoup benefits once they’ve been paid, Calabrese said.

The complicated dispute involves ...