Special report on liability and insurance. An update on assignment of patient benefits under ERISA

While the holdings in Davidowitz and Arkansas Blue Cross & Blue Shield arose in different contexts, they both reflect the courts' increasing willingness to consider the importance of cost containment in the health insurance arena, even though patient accessibility to health care may be restricted as a result. If the holding in Davidowitz is not successfully appealed, providers may need legislative relief in order to retain their ability to take valid assignments of patient claims for payment from ERISA plans. It is uncertain whether such legislation can be sought at the state level or must instead come from Congress due to ERISA preemption of state legislation. Clearly, the district court decision on remand in Arkansas Blue Cross & Blue Shield will be closely watched for any light it may shed on this question. On a pragmatic note, providers who have not entered into "participation" agreements with insurers or other private payors may now have a greater incentive to do so, and "nonparticipating" providers who continue to obtain assignments from patients in order to collect directly from insurers or other private payors should determine on a case-by-case basis whether the source of the patient's benefits is a group health plan--which is likely to fall under ERISA and may contain nonassignment provisions--or some other form of coverage. For an additional perspective on insurers' responses to copayment waivers, see Newsletter, Vol. 6, No. 10, October 1991, at 7.     

Special report on taxation. New IRS revenue procedure clarifies tax classification of limited liability companies

Although its rules are complex, the publication of Revenue Procedure 95-10 will substantially facilitate the use of LLCs in those states with statutes that permit significant flexibility in the structuring of LLCs. Previously, the only way to assure that LLCs in those states would be classified as partnerships for income tax purposes was to obtain a private letter ruling from the IRS, often resulting in lengthy delays. The new revenue procedure should provide sufficient guidance in the vast majority of cases to allow tax counsel to determine the appropriate treatment for tax purposes without having to seek an IRS private letter ruling.     

医疗责任保险的潜在缺陷及其弥补

医疗责任保险作为分散和化解医疗职业风险的重要制度．其功能和价值已为我们所认识．但其运行过程中可能出现的潜在缺陷和弊端却为我们所忽视。本文在借鉴保险理论和对国内外有关医疗责任保险实践分析的基础上．总结了医疗责任保险存在的缺陷，并提出了相关的应对措施。     

医疗责任保险的潜在缺陷及其弥补

医疗责任保险作为分散和化解医疗职业风险的重要制度,其功能和价值已为我们所认识,但其运行过程中可能出现的潜在缺陷和弊端却为我们所忽视。本文在借鉴保险理论和对国内外有关医疗责任保险实践分析的基础上,总结了医疗责任保险存在的缺陷,并提出了相关的应对措施。     

Special report on medical staff relationships. Handling "impaired" health care professionals

Applying the doctrine of corporate negligence, courts will, in appropriate circumstances, deem hospitals and other institutional health care providers responsible for the quality of patient care in their institutions and for the consequences of negligent physician performance that could have been discovered and prevented. See, e.g., Darling v. Charleston Community Memorial Hosp., 33 Ill. 2d 326 (1965), cert, denied, 383 U.S. 946 (1966); Johnson v. Misericordia Community Hosp., 99 Wis. 2d 709 (1981); Elam v. College Park Hosp., 132 Cal. App. 3d 332 (1982). In such a climate, and with Data Bank reporting now a reality, neither institutional providers nor health care professionals on their medical staffs can afford to ignore problems of practitioner impairment. Recognizing this reality, some state laws now mandate an organized approach--such as the establishment of an impaired practitioners committee--to problems of professional impairment. However, whether state-mandated or not, providers must have policies and procedures in place to insure not only that impaired professionals are referred to available treatment programs, but that they fully participate in and complete such programs, and achieve rehabilitation, before they return to practice at the institution. The earlier detection and treatment are initiated, preferably before peer review action becomes necessary, the better for patients, institutions, and practitioners themselves.     

The cost of delegated control: vicarious liability, secondary liability and mandatory insurance

Vicarious liability, secondary liability and mandatory insurance are three systems for attaining judgment-proof or disappearing injurers’ precaution through the direct control of a second party (the vicariously liable principal, the secondary liable party, or the insurer). In this way, the legal system delegates control over some injurers to private entities. Such mechanisms generate monitoring costs. In this paper, we consider who bears the cost of such monitoring, and the effect thereof on the equilibrium level of precautions under different liability rules. We use these findings to explain some of the patterns in the coupling of substantive standards of liability and legal regimes of delegated control.     

中国船舶污染强制责任保险相关规则的探讨

针对中国航运产业小型船舶和内河航运船舶所造成的污染导致受害者很难得到充分赔偿的情况,中国立法作出了种种尝试：在国际法层面上,1999年加入了《1992年国际油污损害民事责任公约》,《2001年国际燃油污染损害民事责任公约》也于2009年对中国生效,但中国没有加入《1996年国际海上运输有害有毒物质责任和损害赔偿公约》。在国内法层面上,包括中国海事局2008年4月出台的《船舶污染事故调查处理管理规定》等规范文件,都没有出现统一详细的有关船舶安全、防范污染的海上强制保险的明确规定。如何在中国建立一个符合航运国情的污染强制责任保险制度成为一个亟须解决的问题。就此制度的建立,结合中国具体发展情况,提出建议与展望。     

Special report on taxation. Court of Appeals denies tax exemption based on "substantial commercial purpose"

When viewed against the background of continuing state and federal legislative efforts to limit the availability of tax-exempt status, the Living Faith case could be seen as yet another indication of difficult times ahead for nonprofit providers. Although it is too early to tell whether this will in fact be the case, tax-exempt providers should be aware of the Living Faith case as perhaps the clearest statement from a federal appeals court in recent years that the operation of an enterprise in too businesslike a manner may make it a taxable activity. Tax-exempt providers that now operate or plan to operate ancillary businesses, whether through joint ventures, wholly-owned subsidiaries, or otherwise, should carefully evaluate such activities against the criteria articulated in Living Faith. This analysis is important not only for purposes of determining whether such activities can qualify for tax-exempt status in and of themselves, but also as an indicator of how such activities might affect the tax-exempt status of the provider.     

我国现行医疗责任保险的作用与缺陷

近年来医疗责任保险已经逐渐在我国各级医院开展。尽管该险种在我国仍处于起步阶段,但已显现出化解医患矛盾、分散医疗责任风险、缓和医患矛盾等积极作用。但与此同时,医疗责任保险亦存在参保医疗机构无法完全从医疗纠纷中解脱、保费过高且赔偿限额过低、医疗责任保险合同条款缺乏对保险公司的约束力、调解中心调处工作需进一步规范等诸多缺陷。只有克服这些不足,完善医疗责任保险服务,才能使其真正有利于医患关系和谐和社会稳定。     

我国现行医疗责任保险的作用与缺陷

近年来医疗责任保险已经逐渐在我国各级医院开展。尽管该险种在我国仍处于起步阶段，但已显现出化解医患矛盾、分散医疗责任风险、缓和医患矛盾等积极作用。但与此同时，医疗责任保险亦存在参保医疗机构无法完全从医疗纠纷中解脱、保费过高且赔偿限额过低、医疗责任保险合同条款缺乏对保险公司的约束力、调解中心调处工作需进一步规范等诸多缺陷。只有克服这些不足，完善医疗责任保险服务，才能使其真正有利于医患关系和谐和社会稳定。     

保险投资高级管理人员的勤勉义务研究

近年来,保险投资出现的问题层出不穷,保险资金运用不当导致保险资金的安全性降低,从而影响保险公司的稳定经营,也影响了保险的社会职能的发挥。本文立足于对保险投资的运用主体即保险投资高级管理人员在运用保险资金时的勤勉义务进行研究,加强保险投资高级管理人员的责任,使之在决定保险资金的运用时做到勤勉、谨慎,降低保险资金运用的风险。