NCAJ Wins Favorable Ruling in BCBS Subrogation Case: Message from NCAJ President Valerie Johnson

Tags: NCAJ News
March 26, 2023   |   Valerie Johnson

Dear Members,

I am pleased to announce that the administrative law judge presiding over BCBS v. N.C. Department of Insurance, et. al. on Friday, March 24, entered a summary judgment in favor of DOI, the Greene family and the North Carolina Advocates for Justice, amicus curiae.

This decision was entered in our hard-fought battle to preserve the civil rights of every health insurance client in North Carolina. Administrative Law Judge Linda F. Nelson determined that the state legislature and the insurance industry have long considered the term “subrogation” to include the right of reimbursement that BCBSNC sought in this case. Therefore, the anti-subrogation rule acts to bar their effort to include a reimbursement provision in their health plans.

Many members of this organization helped make this happen, and NCAJ is especially thankful to Doug Maynard and Jay Trehy, who lent their considerable expertise and volunteered hours of their time representing NCAJ as amicus curiae and the Greene family, respectively. NCAJ depends on the volunteer efforts of its members to further the interests of justice. Doug and Jay answered the call, and their tremendous work led to the right result. We are beyond grateful to them for their extraordinary representation on this important cause.”  

We are also grateful to Anna Choi and Jack Nichols of Hedrick Gardner Kincheloe Garofola, the many members who supported this effort and to NCAJ Past President John McCabe, who during his tenure urged NCAJ to engage in litigation.

“NCAJ took unprecedented action to fight Blue Cross Blue Shield and The Rawlings Company’s brazen attempt to bypass our well-established anti-subrogation regulations,” McCabe said. “For the first time in our 60-year history, we intervened at the trial court level to protect our clients – the citizens of North Carolina. While many people contributed to this undertaking, we are especially indebted to Doug and Jay for the hundreds of hours they donated to fighting this fight. This is a great victory, and we are extremely pleased with Judge Nelson’s decision.” 

Trehy agreed that NCAJ benefited in this litigation from having an exceptional judge, who honed right in on the key issue.

“Adopting our argument about the construction of ‘subrogation of benefits,’ Judge Linda Nelson did a thorough job in crafting an ironclad analysis to support her conclusion that the anti-subrogation regulation’s term, ‘subrogation of benefits’ — as used by BCBS, Rawlings, and the rest of the health insurance industry — refers to the recovery of paid benefits,” Trehy said.

Maynard praised Judge Nelson for doing a great job of parsing the facts and the law.

“She incorporated many of the arguments from the Respondent-Intervenors and NCAJ’s briefs in reaching her analysis,” he said. “We clearly made a difference. It was a collaborative effort. Numerous NCAJ members contributed to the effort with their thoughts, writing and editing during the process.”

With gratitude for your support of NCAJ,

Valerie Johnson, NCAJ President