Archive for the ‘1st’ Category

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

by John H. Eggertsen, Esq. and Michael Friedman, Esq. of SIIA, www.siia.org

I. District of Columbia’s Efforts to Regulate PBMs Preempted by ERISA
In their efforts to combat the ongoing initiatives on the part of several states to regulate the business activities of pharmacy benefit managers (”PBMs”), the PBMs recently won a skirmish. In Pharmaceutical Care Management Association v. District of Columbia, et al. 2009 WL 711771 (D.C.D.C.), a Federal District Court for the District of Columbia held that by regulating the relationship between PBMs and ERISA plans, the District of Columbia’s Access Rx Act of 2004 (the “Act”) “impermissibly intrudes upon a field exclusively reserved for federal regulation,” and thus, is preempted under ERISA. Read more

by Fred Schneyer of PLANSPONSOR, www.plansponsor.com

After tweaking their standard for how federal judges should handle employee benefits denial cases involving a conflicted plan administrator, federal appellate judges have ordered more hearings in just such a case. Read more

[Denmark v. Liberty Life Assurance Co. of Boston, 2009 WL 1219438 (1st Cir. 2009)] For a copy:http://http://www.ca1.uscourts.gov/cgi-bin/getopn.pl?OPINION=05-2877P.01A

The First Circuit has reviewed its analysis of the standard of review applicable in ERISA benefits litigation and found the need for only modest refinements in light of the U.S. Supreme Court’s Glenn decision. Read more