Archive for the ‘ERISA’ Category

Haynes and Boone’s Newsroom – E-Benefits Newsletter, March 2, 2010

A U.S. District Court held that a health plan’s third-party administrator breached its fiduciary duties under ERISA by failing to exercise due care and by failing to administer the plan in accordance with plan documents when it overpaid medical claims. Notwithstanding the fact that the TPA contract disclaimed fiduciary status, the court held that the TPA was an ERISA fiduciary because it exercised discretionary control over plan assets. Hartsfied, Titus & Donnelly LLC v. Loomis Co., D.N.J., No. 08-3329 (WJM) (Feb. 16, 2010).

In Hall v. Liberty Life Assurance Company, No.s 08-4738/4739 (6th Cir. 2010), the plaintiff, . Sonya Hall, had received long-term disability benefits (the “LTD Benefits) for nearly five years through the National City Corporation Welfare Benefits Plan (the “Plan”). Liberty Life Assurance Company of Boston (”Liberty Life”), the third-party claims administrator, terminated the LTD Benefits when it determined that Hall was no longer totally disabled. The Plan then sought reimbursement for overpayment of the LTD Benefits, caused by retroactive Social Security benefits being awarded to Hall. Hall responded by filing suit against the Plan. Read more

MyHealthGuide Source: Meredith Z. Maresca, BNA’s Pension & Benefits Daily, 1/27/2010, www.bna.com

In a decision addressing identification of the proper defendant in a benefit claim action brought pursuant to the ERISA’s civil enforcement provision, the U.S. District Court for the Southern District of Ohio held that the health plan’s TPA potentially could be liable for the alleged wrongful denial of benefits to cover a beneficiary’s bone cancer treatment. Read more

By Andrea Davis

January 25, 2010

The U.S. Supreme Court heard arguments last week in a case that could have far-reaching implications for pension plan administrators and the way in which they interpret the terms of their plans.

“The justices were asking a lot of questions based on the particular facts of the case as opposed to the broader policy implications that this issue presents for all employers,” says Amy Covert, a partner in the labor and employment law department of Proskauer, who attended the session. Read more

This is a huge win for the subrogation industry.

The court held that Sereboff, rather than Knudson, controlled in this case. Like in Sereboff, the Plan targeted specific funds for recovery , Cusson’s LTD payments, and identified the specific portion to which Liberty is entitled— the amount of the overpayment while Cusson was receiving benefits under the LTD Plan. Read more

The Supreme Court has agreed to decide whether the attorney’s fees provision in the Employee Retirement Income Security Act (ERISA) permits courts to award such fees to prevailing parties only. In Hardt v. Reliance Standard Life Ins. Co. (No. 09-448), the Fourth Circuit, in an unpublished opinion, held that an employee who filed a claim in district court alleging that her denial of long-term disability benefits was unlawful was not entitled to an award of attorney’s fees. The lower court had agreed with the claimant and remanded the matter back to the insurance underwriter for reconsideration, which eventually granted her the benefits sought. Read more

Washington, D.C. — On January 18, 2010, The ERISA Industry Committee (ERIC), the Washington, D.C.-based trade association representing America’s major employers, sent a letter to the Administration and key Members of Congress urging that health reform support employer-based health care and expressing concerns over its future viability if certain provisions of the health care reform bills are enacted.

“The employer-based system in this country rests on the foundations of national uniformity, affordability, voluntariness, and the ability to spread risk across the entire employee population. These principals must be maintained in order for the employer-based system to continue to provide 170 million Americans with efficient, effective, and high quality health care,” said ERIC President Mark Ugoretz. Read more

I am proud to be a citizen of the great Commonwealth of Massachusetts today. We truly started another Revolution!!!!

AHIP recently published a new report highlighting trends and innovations in disability income insurance that are helping to address the needs of employers and employees.

The report, Trends and Innovations in Disability Income Insurance, describes strategies that disability income insurers have developed in three key areas: Read more

Jerry Geisel, Business Insurance

WASHINGTON — Congressional action extended a COBRA premium subsidy law which means more work for employers.

Ending weeks of uncertainty, Congress gave final approval and President Obama signed into law late last month a Department of Defense spending bill that includes provisions extending COBRA premium subsidies. Read more

The ERISA Industry Committee

The Health Information Technology for Economic and Clinical Health Act (HITECH Act) was passed on February 17, 2009, as part of the American Recovery and Reinvestment Act of 2009 (ARRA). The stated purpose of the HITECH Act was to promote the adoption and meaningful use of health information technology. As the Act moves through the regulatory process, employers should take note of two developments. Read more

Attached please find a report written by Milliman that indicates on page 5 that hospitals on average earn a profit margin of 23.1% on their commercial business.  the report and that it was based on data from 4,927 hospitals throughout the country

Click here to view study

Ifawebnews.com

By Bob Graham

Self-insured health plans could lose much of their autonomy, as federal health care reform could reshape requirements for their coverage.

“Self-insured employers are used to having a lot of control over their plans and don’t know what little changes [from federal health care reform] can do,” said Ken Huber, senior vice president of the employee benefit group for PSA Insurance & Financial Services in Hunt Valley, Md. Read more

January 6, 2010 • HealthPlanLaw.com

While similar to the Butero test, Davila refines Butero by inquiring about the existence of a separate legal duty, which is not a consideration under Butero.

Moreover, a number of other circuits have recognized Davila’s two-part test as the proper test for complete preemption under ERISA . . . In accordance with the Supreme Court’s directive, we too apply Davila.

Conn. State Dental Ass’n v. Anthem Health Plans, Inc., 2009 U.S. App. LEXIS 28773 (11th Cir. Fla. Dec. 30, 2009) Read more

Fred Hunt, President, SPBA, 1/1/2010, www.SPBATPA.org

Starting The New Year

As we start 2010, this health reform legislative process has achieved one goal. It has brought unity to liberals and conservatives. They share absolute disgust. A leading liberal called it “an ungodly mess of errors, loopholes and massive giveaways”. Most conservatives would say “amen”. It is only the people who play politics as a game who are happy. One of the major players, Senate Majority Leader Reid likes what he calls “vapor” bills and process (vague and ever-changing). So, I predict that there may well not be the actual normal Conference Committee process. Instead, I think we may see just backroom deal-making and then arm-twisting to pass “something” (anything) that can be called health reform and celebrated as a political victory. Read more