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A new federal court case could affect how employer health plans handle medical claims for patients hurt by bad drivers, careless construction crews or other "third parties."
The case involves a health plan subrogation provision. A subrogation provision lets a plan stand in for a plan participant and sue a party accused of injuring the patient.
The plaintiff in the case, Jessica McQueary, was a passenger involved in a motor vehicle collision in Kingston, Oklahoma, in 2024. A liability insurer for the driver of the other vehicle agreed to pay her a settlement.
McQueary alleges in her complaint that Optum Group, the administrator for her health plan, and other defendants are trying to use a subrogation provision to have the settlement pay medical bills she incurred that were unrelated to the motor vehicle collision.
For those claims, the plaintiff "received no compensation from the liability auto insurance carrier" and the claims "were never submitted to the liability auto insurance for consideration," according to a complaint filed Aug. 9 in the U.S. District Court for the Western District of Oklahoma.
McQueary is asking the court to limit the scope of her plan's subrogation claims to the expenses she incurred as a result of the motor vehicle collision
McQueary does not name the sponsor of her coverage in her complaint, but she says her plan was subject to the Employee Retirement Income Security Act, indicating that the plan was an employer-sponsored health plan.
The defendants are Optum Group, UnitedHealthCare Inc. and United HealthCareServices Inc.
Optum is a subsidiary of UnitedHealth Group.
Representatives for McQueary and Optum were not immediately available to comment.
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