December 15, 2011 – The Self-Insurance Institute of America, Inc. (SIIA) today filed an “initial” amicus brief with the Texas State Supreme Court in the case of GPA Holdings, Inc. v. Baylor Health Care Systems. This initial brief supports GPA’s request that the Supreme Court consider arguments to reverse an adverse judgment issued by the Fifth District Court of Appeals. Should the Court agree to hear arguments, SIIA will file a secondary, more comprehensive brief.
At issue is whether third party administrators (TPAs) can be held financially liable for health care services incurred by self-insured group health plans. The Appeals Court declared that such financial liability is lawful.
SIIA’s brief, drafted by attorneys Adam Russo and Ron Peck of the Phia Group, LLC., argues such legal interpretation dictates that TPAs would necessarily be deemed as plan fiduciaries, which clearly conflicts with the Employee Retirement Income Security Act (ERISA). More broadly, SIIA contends that the Appeals Court decision threatens the existence of TPAs in Texas and elsewhere, and in turn, would greatly compromise the viability of self-insured group health plans for most employers.
“This case has significant implications for the self-insurance marketplace so SIIA’s legal action in support of one of its long-time members is clearly warranted,” said association Chief Operating Officer Mike Ferguson. “Unfortunately the number of legal threats to our industry is increasing so SIIA will be announcing a new legal defense initiative after the first of the year.”
The full text of the brief can be accessed by members through the SIIA web site at www.siia.org.
This is a developing story so please watch for additional updates from SIIA.