Adam V. Russo | March 26, 2008
SIIA Members Discuss Increases in Employee Health Care Costs Since 1999.
San Francisco Restaurant Goers Pay for the City’s New Health Care Law.
Massachusetts Health Care Program Getting More Expensive.
Adam V. Russo | March 26, 2008
Benefit Recovery, Inc. sued Louisiana Commisioner of Insurance and lost its case. See entire 5th Circuit Court of appeals decision.
Adam V. Russo | March 21, 2008
Captive insurance companies have steadily increased their share of the growing Alternative Risk Transfer (ART) market in the United States. To meet an increasing need for commercial coverage in short supply, a variety of captive insurance companies, including risk retention groups, have been formed as an alternative to traditional insurance carriers.
As popular “self-insurance” mechanisms for retaining risk, captives continued to strengthen their capital base, according to a July 2007 study based on 175 captives filing annual statements with A.M. Best. Policyholder surplus for the group grew 10.3% in 2006, following 9.6% growth the previous year. (more…)
Adam V. Russo | March 19, 2008
The Minnesota Senate and House both agree that it is essential for victims of the Interstate 35W bridge collapse to be compensated for their losses, however, the amount of proposed settlement funds are in opposition. The Senate bill would establish a $25 million fund while the House bill would establish a $40 million fund. The Senate bill would set a limit on how big the victim’s settlement would be. The Senate bill voids settlement negotiations based on the severity of injuries, loss of income, or pain and suffering for family members, whereas, the House bill proposes no such limitations on individual victim settlements. (more…)
Adam V. Russo | March 14, 2008
Roy F. Harmon III has posted recent U.S. Department of Labor legal endeavors regarding employee benefit plans on his Health Plan Law blog (http://healthplanlaw.com/). In recent months, most legal controversies regarding ERISA plans have related to plan administration and violations of fiduciary duty. Whether it is an individual plan member suing to enforce plan terms (see LaRue v. DeWolff, Boberg & Associates below) or the U.S. Department of Labor investigating irresponsible management of plan funds (the sale, for example, of a $28 million dollar plan investment for $4.5 million), fiduciary duties to plan members is at the forefront of recent ERISA law.
Adam V. Russo | March 14, 2008
The Supreme Court has held that if a self-funded plan administrator reserves the discretionary right to interpret plan terms, in the plan document itself, courts will apply an arbitrary and capricious standard, questioning the administrator’s interpretation only if it has no reasonable basis. Firestone Tire & Rubber Co. v. Bruch, 489 U.S. 101, 109 S. Ct. 948 (1989). Since that decision was handed down, the courts have been more strict in their analysis of plan terms, and have been quick to find fault with plans’ discretionary provisions. (more…)
Adam V. Russo | March 14, 2008
In North Dakota, the State’s workers’ compensation carrier was accused of faulty claims handling and administration. Workforce Safety and Insurance was therefore examined by a third party, Marsh USA, Inc., at the behest of Gov. John Hoeven. Marsh determined that the carrier was not unfairly denying injured workers’ claims. (more…)
Adam V. Russo | March 14, 2008
A Louisiana State Law requiring that insureds be made whole before an insurance carrier could seek reimbursement was upheld by the 5th Circuit, Benefit Recovery, Inc. v. Donelon, 2008 WL 642972 (March 11, 2008). Note that the decision only applies to plans that are not self-funded, but will apply to plans that are fully insured, and governmental plans, even if ERISA otherwise applies.
