Actuarial Expert Discusses Federal Injury Compensation For Deceased Patient

Case Overview

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.

Questions to the Vocational expert and their responses

Please describe your background as an actuary.

I am a fellow of the Society of Actuaries, an enrolled actuary, and a member of the American Academy of Actuaries.

Have you worked with ERISA?

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 what ways could a self-funded health care plan differ from an insurance policy?

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 expert

This highly qualified expert has 33 years of experience as pension actuary, including 27 years as a consultant. He earned his BA from the University of Chicago. He is an Enrolled Actuary, a fellow of the Society of Actuaries, and a member of the American Academy of Actuaries. He also frequently gives presentations to actuary societies, including the Society of Actuaries and Conference of Actuaries in Public Practice, and has had 14 articles published in the Enrolled Actuaries Report. Currently, he is the President of a California consulting company.