Market Overview

2012 U.S. Healthcare With ERISA Gold Teeth: Supreme Court Decisions Changed Your Reimbursement Rights


New ERISAclaim.Com Webinars To Examine The U.S. Supreme Court Decisions That Have Significantly Changed Reimbursement Rights For Patients, Doctors & Hospitals In 2011, Regardless Of The Outcome Of The Supreme Court Decision In 2012 On ObamaCare.

Hanover Park, IL (PRWEB) January 02, 2012 offers Webinars to examine the U.S. Supreme Court decisions that have significantly changed the reimbursement rights for patients, doctors & hospitals in 2011 or will change in 2012. In 2011, the Supreme Court has completely changed the healthcare legal landscape, correcting federal law, ERISA, from no remedies (“No Teeth”) to “appropriate equitable relief” with “make-whole remedies” or surcharge (“Gold Teeth”). ERISA is the primary federal law governing all employer sponsored health claims for 36 years. Regardless of the outcome of the expected high court decision in 2012 on the constitutionality and severability challenge on the individual mandate of PPACA, aka ObamaCare, healthcare reimbursement laws under ERISA and patient rights have been changed for better for the first time in past 36 years. The Webinars will explain what the Supreme Court decision practically means to you in all claims denials and delays.

“For 36 years, patients and doctors as well as lawyers have complained about no protections (“no teeth”) from ERISA when patients died and doctor's bills denied, on May 16, 2011, Supreme Court corrected all of these errors in the laws by giving ERISA ‘Gold Teeth': make-whole remedies or ‘surcharge'”, says Dr. Jin Zhou, president of, a national expert on PPACA and ERISA appeals and compliance.

“Even if the Supreme Court rules in 2012 that the individual mandate is unconstitutional and not severable from the entire PPACA, ERISA still governs and provides the unprecedented protections for more than 80-90% of non-Medicare/Medicaid claims in USA, as PPACA simply adopts ERISA in its entirety, with some new provisions, as PPACA Patients Bill of Rights. PPACA claims regulations went into effect on Sep. 23, 2011 and will be fully enforced in 2012,” explained Dr. Zhou.

“If the Court finds for PPACA, ERISA will govern almost all health claims outside of Medicare and Medicaid programs,” added Dr. Zhou.

The's 2012 Webinars start at $5,000 per 2-hour session and will cover the following topics:

1.    Supreme Court decision in Cigna Corp. v. Amara, (No. 09–804) on May 16, 2011:
A)    corrected ERISA errors in the law for 36 years that ERISA provides no remedies for fiduciary breach, and
B)    ERISA provides "appropriate equitable relief" in forms of surcharge or make-whole remedies for fiduciary breaches, and
C)    Plan SPD (Summary Plan Description) is not enforceable if inconsistent with or not contained in final plan documents or master plan document.
2.    Supreme Cigna decision is applicable for all health care claims denials and delays for all providers.
3.    DOL Kenseth Amicus Brief, in support of patient. “Kenseth claims that Dean violated its duties as an ERISA fiduciary when it erroneously pre-authorized her surgery and left her liable for over $77,000 in medical bills”. A)-6-13-2011.htm">
4.    DOL Affordable Care Act Regulations and Guidance:
5.    How to correctly apply or comply with Supreme Court Cigna decision in all of your health claim denials or delays, such as policy exclusion or limitation, medical necessity or experimental/investigation, UCR / Medicare fee, bundling/down coding, pre-certification, no direct payment, overpayment, pre-payment reviews and delay/denials, and more…..

In particular, the Supreme Court stated in Cigna Corp. v. Amara on May 16, 2011:

  •     “We cannot agree that the terms of statutorily required plan summaries may be enforced as the terms of the plan itself.”
  •     “We conclude that the summary documents, important as they are, provide communication with beneficiaries about the plan, but that their statements do not themselves constitute the terms of the plan”.
  •     "The surcharge remedy extended to a breach of trust committed by a fiduciary encompassing any violation of a duty imposed upon that fiduciary."
  •     "Thus, to obtain relief by surcharge for violations of §§102(a) and 104(b), a plan participant or beneficiary must show that the violation caused injury, but need show only actual harm and causation, not detrimental reliance. Pp. 20–22."
  •     “To be sure, a fiduciary can be surcharged under §502(a)(3) only upon a showing of actual harm, and such harm may consist of detrimental reliance. But it might also come from the loss of a right protected by ERISA or its trust-law antecedents. It is not difficult to imagine how the failure to provide proper summary information here, in violation of ERISA, injured employees even if they did not them-selves act in reliance on the summaries. Thus, to obtain relief by surcharge for violations of §§102(a) and 104(b), a plan participant or beneficiary must show that the violation caused injury, but need show only actual harm and causation, not detrimental reliance.”

To find out more about PPACA Claims and Appeals Compliance Services from

Located in a Chicago suburb in Illinois, for over 11 years, is the only ERISA & PPACA consulting, publishing and website resource for healthcare providers in the country. offers free webinars, basic and advanced educational seminars and on-site claims specialist certification programs for doctors, hospitals and commercial companies, as well as numerous pending national ERISA class action litigation support. Dr. Jin Zhou is regarded as the industry “Godfather of ERISA claims” for healthcare providers.

For any questions, please contact Dr. Jin Zhou, president of, at 630-808-7237.
JIN ZHOU                                                                                                
1260 Bamberg Court
Hanover Park, IL 60133
Tel: (630) 808-7237
Fax: (630) 736-1439        


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