Archive for the ‘10th’ Category

– On December 9, 2009, the United States Court of Appeals, Tenth Circuit, affirmed the federal government’s position that private insurance companies are “plans” and therefore subject to federal jurisdiction. (US vs. Frost)

Although other federal courts have held that contracts issued by insurance companies may be subject to federal jurisdiction under Title 18 Section 1347, US vs. Frost is the first case an insurance company itself has been held to be a “plan,” because, as the government claimed in this case, all insurance companies are “plans.” Read more

by Joe Hanel of The Durango Herald, www.durangoherald.com

DENVER – Stephen and Naomi Dobbs have some of the same complaints about stonewalling by their health-insurance company as many people.

But when the Durango couple sued Anthem Blue Cross & Blue Shield, they got caught between two complex areas of the law – health insurance and Native American tribal sovereignty. Read more

In Administrative Committee of the Wal-Mart Stores, Inc. v. Gamboa, 479 F.3d 538 (8th Cir. 2007), an ERISA plan administrator brought suit seeking equitable reimbursement from a plan participant who had received a settlement from a tortfeasor. Although the reimbursement provision was contained in an SPD for a health plan, the employer had no formal written health plan. Reversing summary judgment for the participant, the Eighth Circuit held that the plan administrator reasonably construed the SPD to be on the plan document for purposes of a group health plan in the absence of any formal plan and that the reimbursement provision in the SPD was therefore enforceable. Read more

The Tenth Circuit Court of Appeals held in Hollingshead v. Blue Cross Blue Shield of Oklahoma, 2007 WL 475832, 39 EBC (BNA) 2732 (10th Cir. 2007), that when a Plan states it will pay for only one organ transplant, the Plan may exclude charges incurred for the replacement of a previously transplanted organ that has failed. Read more