bhoffman | September 1, 2010
SIIA, www.siia.org
By Thomas A. Croft, Esq.
I. The Supreme Court Clarifies ERISA Attorney Fee Provision
We have two reasons for reviewing Hardt v. Reliance Standard Life Ins. Co., 130 S. Ct. 2149 (2010). First, it is the latest ERISA decision from the Supreme Court cases define ERISA jurisprudence, they cannot be ignored. Second, the case addresses an [...]
bhoffman | August 27, 2010
Employer’s Guide to Self-Insuring Health Benefits, Thompson Publishing Group
Employers and other plan administrators are due greater deference in their benefits plan decisions than some lower courts have allowed, the U.S. Supreme Court ruled after admonishing two lower courts for failing to follow the High Court’s prior decisions establishing ERISA law on plan administration.
The High Court [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Victims of accidents in subrogation/reimbursement cases have emotional appeal when they argue that tort settlements are reduced without some consideration of the fact that they were not “made whole” or had their recoveries diminished by not requiring a recovering plan to share the legal fees they incurred in making the settlement. There [...]
bhoffman | August 12, 2010
CCH® BENEFITS, www.hr.cch.com
California
The California Public Employee’s Retirement System (CalPERS) has approved an average increase of more than 9% in health premiums next year for state and local government workers. CalPERS blamed the rate increase on rising costs for hospital care, doctor visits, and prescriptions. The increase will mean higher premiums for public agencies and their [...]
Adam V. Russo | July 9, 2010
This year, while the Sixth Circuit held that an illegal act exclusion could not be applied because of a lack of causation between the illegal act and the injuries for which benefits were sought, an Indiana district court found that an administrator’s decision to deny health benefits based on a plan exclusion was “not reasonable” [...]
Adam V. Russo | July 9, 2010
In addressing the contents of the administrative record that must be disclosed to a claimant, the court in Mondry v. American Family Mutual Insurance Co. concluded that a claim administrator’s internal documents and guidelines could be subject to mandatory production in ERISA cases if the claims administrator expressly cites to such documents and equates them [...]
Adam V. Russo | July 9, 2010
In considering the administrative record in ERISA benefits cases, courts this year addressed both what must be included in the administrative record and the admissibility of its contents. In Nally v. Life Insurance Co. of North America, plaintiff argued her deceased husband’s employee benefit plan impermissibly relied on evidence such as police and expert reports [...]
Adam V. Russo | July 9, 2010
The special administrator of the estate of a deceased employee, who was an ERISA plan participant, brought action against the employee’s former employer for breach of fiduciary duty seeking to recover the amount of the employee’s life insurance coverage before his first medical leave of absence, which lapsed when the employee was terminated without notice.
Adam V. Russo | July 9, 2010
Like Ross, the Ninth Circuit issued a similar ruling in Standard Insurance Co. v. Morrison. Montana requires its commissioner of insurance to disapprove any [insurance] form…if the form…contains…any inconsistent, ambiguous, or misleading clauses or exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract…
Adam V. Russo | July 9, 2010
Defendant-appellee Ken Ross is the commissioner of the Michigan Office of Financial and Insurance Services (OFIS). OFIS is responsible for licensing, examining, and supervising insurers and nonprofit health care corporations doing business in Michigan. To this end, OFIS’s authority includes the power to disapprove insurance policy forms and documents associated with such forms that are [...]
Adam V. Russo | July 9, 2010
Juli Pollitt, a federal employee, had health insurance administered by Health Care Service Corp. (HCSC). In July 2007, HCSC stopped paying claims submitted on behalf of Pollitt’s son Michael and began trying to collect from health care providers any payments made on Michael’s behalf since 2003. According to HCSC, it did this because the Department [...]
Adam V. Russo | July 9, 2010
Sandra Chronister was employed as a nurse at Baptist Health in Arkansas. In 1995, she was injured in a car accident, and thereafter sought disability benefits under Baptist Health’s long-term disability plan, which was insured and administered by Unum Life Insurance Co. of America. Unum initially granted her application for disability benefits. At Unum’s urging, [...]
Adam V. Russo | July 9, 2010
In light of the Supreme Court’s decision in Glenn, the Second Circuit has reassessed its standard of review governing cases that challenge an ERISA plan administrator’s decision to deny disability benefits in cases where the administrator has a conflict of interest because it has the discretionary authority to determine the validity of the employee’s claim [...]
Adam V. Russo | June 21, 2010
www.plansponsor.com
June 8, 2010 (PLANSPONSOR.com) – The U.S. District Court for the Western District of Wisconsin has found that an employer did not breach its fiduciary duties by failing to inform a former employee and his wife about all of their benefit options.
Adam V. Russo | June 17, 2010
From the Bench; By John H. Eggerstsen, Esq. and Michael Friedman, Esq.
This month’s From the Bench will review just one case-the U.S. Supreem Court’s most recent ERISA decision, Conkwright v. Frommert, No. 08-810 (April 21,2010). Amidst all the heady intensity surrounding the recently passed health care reform legislation, it is salutary perhaps to realize that [...]
