Angry School District Employees Confront District Trustees
Fiduciary Liability Insurance – Here’s why you need it……………….
A self-funded Texas school district provides a group heath insurance plan which incorporates a proprietary PPO network. School district trustees have no idea what they have committed to paying PPO network providers thereby purposely unable to fulfill their fiduciary duties.
Joe Sixpack, a plan member, receives care from a PPO network hospital. The PPO network allowed amount is 550% of Medicare. Joe is responsible for a deductible plus 20% coinsurance applied against 550% of Medicare, an amount he can’t afford.
Joe learns his co-worker used a different in-network hospital whose allowed amount was 200% of Medicare to which he was subject to a far less out-of-pocket expense. Coinsurance against 200% of Medicare is far less than under 550% of Medicare. “That’s not fair! District trustees didn’t have my back!” thought Joe.
Joe’s next door neighbor, Perry Mason III, files suit against the district for breach of fiduciary duties. Other plan members come forward with similar stories and a class action suit is filed against the district and each trustee individually.
All Hell breaks out. Gaps in coverage threaten to fail to remedy a potential plaintiff’s win. Trustees head to the golf course in search of their broker. Alas, he’s sail fishing in Costa Rica and won’t be back anytime soon, if ever.
Settlement offers abound early on to no avail. Finally an offer to settle too good to refuse is accepted.
The district changes health insurance companies and continues to access a PPO network they can’t see nor audit. They buy the best fiduciary liability insurance money can buy.
Joe buys that bass fishing boat he’s always dreamed about and divorces his wife. Life is good. And life goes on……………
Meanwhile, back at the ranch, eager attorneys reach out to RiskManagers.us. “If you know of any similar situations and we bring suit and win, either through settlement or through jury trial, we will pay you a contingency fee of 5%. Your task is to find us as many pissed off plan members as you can.”
Finding pissed off plan members is not hard to do these days.
