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 | May 12, 2010
Underpayment of a benefit constitutes a repudiation of full benefits and triggers the statute of limitations. Id. at 521. The record is clear that the plaintiff was well aware of the underpayment more than four years before filing suit, as evidenced by a number of letters between the defendant and Mr. Bryer’s then-counsel, culminating in [...]
Adam V. Russo | January 29, 2010
January 22, 2010 (PLANSPONSOR.com) – A federal court has refused to dismiss a claim by a Jersey Construction employee that he was fired for pursuing health benefits for his wife’s chemotherapy.
The U.S. District Court for the District of New Jersey said it found that Christian Pailleret stated sufficient facts to support a prima facie case [...]
Adam V. Russo | December 8, 2009
Davis v. AK Steel Corp., 2009 WL 3853608 (W.D. Pa. 2009)
The trial court in this case found that an employer’s SPD hand-delivery process satisfied DOL regulations, which require that the process be reasonably calculated to ensure that recipients receive SPDs and likely to result in full distribution. The employer had denied an employee’s claim for [...]
Adam V. Russo | September 18, 2009
by Roy Harmon, III, www.healthplanlaw.com
A typical plan will contain an exclusion for accidents or injuries resulting from intoxication, unlawful conduct and so forth. How the plan states the exclusion can vary quite a bit, and the distinctions can make a significant difference in outcomes.
Adam V. Russo | May 27, 2009
by John P. McLaughlin and Alexandra Bak-Boychuk of Ballard Spahr Andrews & Ingersoll, LLP, www.ballardspahr.com
Cities and municipalities may recover benefits paid under the Pennsylvania Heart & Lung Act (HLA) through subrogation of an employee’s tort recovery. In City of Wilkes-Barre v. Robert P. Sheils, Jr., the U.S. Court of Appeals for the Third Circuit upheld [...]
Adam V. Russo | May 20, 2009
Estate of Schwing v. Lilly Health Plan, 2009 WL 989114 (3rd Cir. 2009)
The circuit courts continue to address the U.S. Supreme Court’s Glenn decision on the standard of review applicable in ERISA benefits litigation. The more deferential standard applies if the plan document gives the plan decision maker “discretionary” authority to make benefit decisions. In [...]
Adam V. Russo | May 13, 2009
Generally, well-drafted subrogation and reimbursement provisions allow a health plan to recover benefits paid for medical expenses even if a tort settlement is structured so as to not reimburse the injured party for medical expenses caused by the individual making the settlement. However there are exceptions to this rule if the plan’s subrogation and reimbursement [...]
Adam V. Russo | March 23, 2009
In the case of Humana Health Plans, Inc. v. Patti Powell, 07CV385 (W.D. Ky. Feb. 25, 2008), the Western District of Kentucky issued an important decision regarding ERISA preemption of Kentucky Stat. § 441.188. This Kentucky Statute at issue in the case limits a subrogated party’s rights where that party fails to intervene in the [...]
Adam V. Russo | February 9, 2009
Based on the high volumn of requests, click here to see the entire case.
Adam V. Russo | October 6, 2008
When negotiations concerning a possible settlement of plaintiff’s subrogation claim failed, Ms. DeBoer demanded her share of the settlement, and the attorney defendants paid over to her the amounts they had recovered, less their counsel fees and expenses. In doing so, they carefully notified Ms. DeBoer of her obligation to repay the plaintiff’s subrogation claim, [...]
Adam V. Russo | July 29, 2008
The United States District Court for the District of New Jersey, following a hearing on July 24, 2008, has approved a $250 million settlement in the matter of plan members versus Health Net, Inc.
Adam V. Russo | July 18, 2007
In Cheryl Street v. Ingalls Memorial Hospital, (2007 U.S. Dist. Lexis 18643), the Northern District Court of Illinois held on March 15, 2007 that just as a Plan must identify funds prior to seeking equitable relief in Federal Court, so too must relief sought by participants be specifically identifiable. In one case, decided by the [...]
