cmonfils | July 4, 2011
www.workforce.com June 27, 2011
The 9th U.S. Circuit Court of Appeals circuit court June 23 decided that retirement-plan participants can sue third-party insurers under the Employee Retirement Income (more…)
cmonfils | June 13, 2011
MyHealthGuide Source: PharmaSentry, 6/7/2011, Release
Editor’s Note: This week, the FDA warned that 80-milligram dose of simvasatin (Zocor) may cause muscle damage. Simvasatin is a member of a group of drugs called statins. They lower LDL cholesterol. People taking the drug may feel pain, tenderness or weakness. In extreme cases, kidney damage may occur. Only people who have been taking this dose for more than a year without problems should continue taking it, the FDA said. New patients should start on a lower dose.
At the same time, a study reported by PharmaSentry showed that statins reduced healthcare costs (described below). (more…)
cmonfils | May 26, 2011
www.healthplanlaw.com Roy Harmon III May 17, 2011 ·
Why the Court embarks on this peculiar path is beyond me. It cannot even be explained by an eagerness to demonstrate — by blatant dictum, if necessary — that, by George, plan members misled by an SPD will be compensated. (more…)
cmonfils | May 26, 2011
www.haynesboone.com 05/24/2011
The Supreme Court in CIGNA Corp. v. Amara held that plan terms cannot be reformed under Section 502(a)(1)(B) of ERISA based on a misleading summary plan description (SPD). Despite this narrow ruling, six justices further stated that reformation may be an appropriate equitable remedy under Section 502(a)(3) of ERISA. (more…)
cmonfils | May 26, 2011
www.laborlawyers.com Date: 5/16/2011
On May 16, 2011, the Supreme Court clarified the showing of harm that a participant must demonstrate in order to recover on a claim involving a Summary Plan Description (SPD) that conflicts with the terms of its underlying plan document. The Supreme Court explained that the requisite level of harm for a particular case will be dependent upon the applicable equitable theory of relief. If a plaintiff can satisfy one of the standards, it may then be rebutted by the defendant – if the defendant can demonstrate that the inconsistency was a harmless error. (more…)
cmonfils | May 16, 2011
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 5/10/2011, www.thompson.com
Case: Montefiore Medical Center v. Teamsters Local 272, 2011 WL 1498823 (2nd Cir., 4/21/2011
A health provider argued that an otherwise valid assignment of benefits is a “nullity” whenever care is provided in-network. While novel, the health provider’s approach was unsuccessful in trying to avoid ERISA preemption of its state-law claims against an employer plan. (more…)
cmonfils | May 16, 2011
www.ebn.benefitnews.com By Mary Nell Billings May 1, 2011
Simplicity should be a key goal in plan design, plan objectives and participant communications. Regulations make this challenging, but the benefits of simplicity are many.
The Employee Retirement Income Security Act could never be described as simple, streamlined or straightforward. So yes, ERISA and KISS (Keep It Simple, Stupid) are two acronyms that seem like strange bedfellows. Granted, there are things that will never be simple about the design and administration of ERISA plans, but my challenge to you is to change your perspective and think about where you can follow the tenet of simplicity. (more…)
cmonfils | May 9, 2011
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 5/4/2011, www.thompson.com
Case: Hansen v. Harper Excavating, 2011 WL 1379821 (10th Cir., April 13, 2011)
Fine distinctions about an employee’s status as a non-ERISA beneficiary allowed his state-law case — even though he had already prevailed on an ERISA complaint based on closely related facts — to survive, a U.S. appeals court has ruled in the above case. (more…)
cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
It would be very difficult to prevail in a lawsuit against an ERISA health plan or its claim administrator that would undermine a plan’s efforts to enforce its subrogation rights. Most self-insured ERISA plans have well-drafted provisions that make it almost impossible for such a lawsuit to prevail. But if the plan participant’s attorney could put together a class action against the plan, it could provide an opportunity for a favorable settlement. That’s because the prospect of defending a class action could put considerable pressure on a plan or its claim administrator to settle the plan participant’s claim. Such litigation would be very costly for the plan to defend. And if there is any possibility that the plan language has a weak spot, there could be rather significant liability to a large number of claimants. (more…)
cmonfils | May 3, 2011
April 26, 2011 11:03 ET
Ohio State Chiropractic Association (OSCA), Joined by Other Providers, Associations, DME Provider and Ambulatory Surgical Center (ASC), Filed Its First Amended ERISA Class Action Complaint Against UnitedHealth Group and OptumHealth, for ERISA Violations in Its Abusive Overpayment Recoupment, Pre-Service Plan and Concurrent Claim Denials (more…)
cmonfils | April 25, 2011
By Stanley D. Baum on April 21, 2011
In Hansen v. Harper Excavating, Inc., No. 08-4089 (10th Cir. 2011), the plaintiff, Jeffery Hansen (“Hansen”), had worked for the defendant, Harper Excavating, Inc. (“Harper”), for six months beginning in 2003. During this time, he attempted to enroll in Harper’s health insurance plan (the “Plan”). The Plan is subject to ERISA. However, unknown to Hansen, Harper never enrolled him in the Plan, although it did deduct Plan contributions from his paycheck. (more…)
cmonfils | March 25, 2011
Carolinas HealthCare System’s tie to health benefits firm has led to conflict questions.
By Ames Alexander aalexander@charlotteobserver.com Posted: Thursday, Mar. 17, 2011
The U.S. Labor Department is investigating Carolinas HealthCare System following questions about whether its relationship with a health benefits company it co-owns poses a conflict of interest.
The company, MedCost, provides health benefits to the Charlotte-based hospital chain’s roughly 30,000 employees. (more…)
cmonfils | March 25, 2011
March 14, 2011 — The International Chiropractors Association (ICA) announced today that its claims challenging the overpayment recovery practices of various Blue Cross Blue Shield entities were upheld by Judge Matthew F. Kennelly of the United Stated District Court in Chicago, IL, in Pennsylvania Chiropractic Association, et al. v. Blue Cross Blue Shield Association, et al., Case No. 1:09-cv-05619. (more…)
cmonfils | March 25, 2011
www.marketwire.com Mar 18, 2011 11:07
Ohio State Chiropractic Association (OSCA) Announces Continued PPACA Claims Regulation Training in an Effort to Meet the Deadline on July 01, 2011 for Full Enforcement of Federal Health Reform Law; This is Following the Filing of an ERISA Class Action Against UnitedHealth Group for ERISA Violation; OSCA Leads the Nation’s Providers in Advocating Patient’s Bill of Right for Healthcare Coverage (more…)
