cmonfils | September 16, 2011
The Self-Insurer August 2011
From the Bench Michael Friedman and John Eggertsen
The U.S. Supreme Court, in GIGNA Corp v. Amara, et al., 563 U.S., 2011 WL 1936077 (May 16, 2011), revisited, and likely expanded, the scope of equitable remedies available under ERISA § 502 (a)(3). The Court also rejected Plaintiff’s effort to sue under the terms of the SPD as opposed to the terms of the actual ERISA plan document. (more…)
Category: 2nd, 9th, ERISA, Summary Plan Description, Supreme Court |
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cmonfils | May 16, 2011
www.myhealthguide.com
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…)
Category: 2nd, ERISA, PPOs |
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cmonfils | March 1, 2011
www.wsj.com
FEBRUARY 28, 2011. By AVERY JOHNSON
Maggie Haslam’s five-year-old autistic son, Drew, has undergone intense behavioral, physical and speech therapy that helped him learn to dress himself and communicate such concepts as “over” and “under.”
The next big issue for the federal health law as it moves toward implementation is how regulators will define so-called essential benefits—the basic medical services that health plans must cover under the law. (more…)
Category: 2nd, Health Care Legislation |
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Adam V. Russo | 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 also admonished the current administration as well as courts for attempting to introduce more complex, inefficient and costly requirements in plan decision-making, and for encouraging court interference in those plan decisions. (more…)
Category: 2nd, ERISA, MetLife v. Glenn, PPACA, Summary Plan Description, Supreme Court |
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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 and pays the benefits under the policy. In McCauley, the Second Circuit abandoned its prior standard of review, which allowed courts to review de novo the administrator’s decision when it is shown that a conflict of interest actually influenced that decision, and adopted the Glenn standard that such a conflict of interest is to be “weighed as a factor in determining whether there was an abuse of discretion.” (more…)
Category: 2nd, Claims Procedures, Claims Review, Conflict of Interest, MetLife v. Glenn |
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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 the day-to-day administration of ERISA plans proceeds apace and the issues that must be addressed by the courts are perhaps more mundane though likely not less challenging. (more…)
Category: 2nd, ERISA, Federal Circuits, Supreme Court |
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Adam V. Russo | May 24, 2010
On April 21, 2010, in the case of Conkright v. Frommert, 559 U.S. ___ (2010), the United States Supreme Court held that where a plan administrator is granted deference in exercising its discretionary authority, and the administrator subsequently issued an incorrect interpretation related to the plan document, absent malice, the plan administrator is not disqualified from making future interpretations of the plan on the same or related matters. (more…)
Category: 2nd, ERISA, Federal Circuits, Supreme Court |
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Adam V. Russo | May 4, 2010
The U.S. Supreme Court’s recent Conkright v. Frommert decision is an important confirmation of a plan administrator’s authority to interpret the terms of a benefit plan and serves as a reminder for plan sponsors to review the terms of their benefit plans to ensure that they contain sufficient discretionary language. (more…)
Category: 2nd, ERISA, Supreme Court |
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Adam V. Russo | July 28, 2009
In MacLeod v. Proctor & Gamble Disability Benefit Plan, 460 F. Supp. 2d 340 (D. Conn. 2006) the administrator denied the participant’s application for benefits on the grounds that the claimed disability resulted from the participant’s prior military service and therefore was excluded from coverage. At oral argument, the administrator admitted that its decision was based on the “categorical military exclusion” and did not entail an individualized consideration of the particular facts of the application. The plan at issue, however, specifically provided that in the event of an “illness, accident or injury occurs while the Participant is working for pay for some person or organization other than the Company, payment of benefits under the Plan shall be made only at the discretion of the [administrator] after their review of the facts of the case.” Although the court did not find that the administrator’s conclusion that the participant’s disability occurred during his time in the military was arbitrary and capricious, it concluded that the manner in which the administrator evaluated the claim was an unreasonable interpretation of the plan language and remanded the matter.
Category: 2nd, Exclusion, Plan Language |
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Adam V. Russo | March 20, 2009
from The Advocate Staff of The Connecticut Post
Updated: 03/07/2009 08:09:09 AM EST
It’s rare for the U.S. Supreme Court to opine on retirement plan beneficiary designations, so when it does, it’s newsworthy. A few weeks ago, the court decided a case, Kennedy v. DuPont Savings and Investment Plan, that involved whether a form as benign as a beneficiary designation overpowers a divorce decree. (more…)
Category: 2nd, ERISA |
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Adam V. Russo | January 5, 2009
McCauley v. First Unum Life Ins. Co., 2008 U.S. App. LEXIS 26094 (2nd Cir.) (December 24, 2008) is an important post MetLife v. Glenn decision in the Second Circuit. The Court found First Unum’s past history as being a factor in evaluating a conflict of interest.
The Court mentioned the fact that First Unum had a history of biased claims administration and how First Unum has a disturbing pattern of erroneous and arbitrary benefits denials, bad faith contract misinterpretations, and other unscrupulous tactics. The court listed more than thirty cases in which First Unum’s denials were found to be unlawful, including one decision in which First Unum’s behavior was “culpably abusive. (more…)
Category: 2nd |
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Adam V. Russo | June 19, 2008
U.S. District court Judge Harold Baer has ruled that Allianz S.E. is primarily entitled to recoveries from third parties found liable for damages from the Sept.11, 2001 terrorist attacks. World Trade Center leaseholder Silverstein Properties Inc. challenged the ruling claiming that the $433 million settlement of the $3.55 billion property limit from Allianz S.E. last year was insufficient. (more…)
Category: 2nd, Made Whole Rule |
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Adam V. Russo | April 21, 2008
The fact that an individual had medical treatment for a condition before an accident and subsequently suffered an injury that required additional treatment should not defeat a plan’s right to reimbursement for benefits paid on account of the treatment resulting from the accident. A U.S. District Court reached that conclusion in Schaffer v. Mancini, 2007 WL 2725569 (N.D. N.Y., Sept. 13, 2007). (more…)
Category: 2nd |
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