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 | July 28, 2009
In Thomas v. Reliance Standard Life Insurance Co., 487. F. Supp. 2d 697 (D.S.C. 2007), the court examined whether death by asphyxia from vomitus resulting from drug self-administration was an accident within the terms of an ERISA-governed policy. Reliance Standard denied benefits pursuant to the policy’s exception for losses caused by suicide or intentionally self-inflicted [...]
Adam V. Russo | July 28, 2009
In Eckelberry v. Reliastar Life Insurance Co., 469 F.3d 340, the Fourth Circuit affirmed the insurer’s determination that the decedent’s fatal automobile collision did not qualify as an “accident” as defined under the subject ERISA plan. The insured died after he lost control of his car and collided headlong into the rear of a tractor [...]
Adam V. Russo | June 29, 2009
by Amanda Bronstad of The National Law Journal, www.law.com
An association representing the restaurant industry has filed a petition for writ of certiorari before the U.S. Supreme Court to overturn a ruling by the U.S. Court of Appeals for the 9th Circuit upholding a law requiring employers in San Francisco to provide health insurance to their [...]
Adam V. Russo | May 13, 2009
In Arnold v. Hartford Life Insurance Co.( 542 F. Supp. 2d 471 (W.D. Va. 2008), Hartford denied a beneficiary’s claim for accidental death benefits, concluding that the insured’s death was not due to an “injury” as defined in the policy. The insured died at the scene of a motorcycle crash. The immediate cause of death [...]
Adam V. Russo | March 24, 2009
Since the Glenn decision, a number of circuits have had an opportunity to consider and apply the Glenn Court’s reassessment of ERISA’s standard of review.Roumeliote v. LTD Plan for Employees of Worthington Industries, 298 Fed. Appx. 472 (6th Cir. 9/11/2008).
This was the first circuit to apply Glenn since Glenn was a Sixth Circuit decision and [...]
Adam V. Russo | January 9, 2009
Champion v. Black & Decker Inc., 2008 WL 5377692 (4th Cir. 2008)
McCauley v. First Unum Life Ins. Co., 2008 WL 5377680 (2nd Cir. 2008)
Adam V. Russo | December 3, 2008
In Gagliano v. Reliance Standard Life Ins. Co., 2008 WL 4916330 (4th Cir. 2008), an employee’s claim for long-term disability benefits was denied on the ground that she was not disabled under the terms of the plan. The court ordered an independent medical examination that stated the employee was disabled but the plan administrator (who [...]
Adam V. Russo | May 19, 2008
By Ron E. Peck, Esq.
If you have read the postings below (addressing the ongoing Supreme Court case of MetLife v. Glenn) you will note that the matter of what standard of review a Court applies when reviewing an administrator’s decision, is a major topic of conversation. The issue literally dominates how much power administrators will [...]
Adam V. Russo | April 17, 2008
This 4th Circuit case is another addition to the growing list of cases holding that contractual disputes between plan sponsors and claims administrators are subject to state law.
The defendant in this case, Information Systems and Networks Corp. (“ISN”) established a self-funded health benefit plan governed by ERISA. ISN purchased insurance from the plaintiff in this [...]
Adam V. Russo | February 20, 2008
The Supreme Court held in LaRue v. DeWolff, Boberg & Associates that ERISA §502(a)(2) authorizes recovery for fiduciary breaches that impair the value of plan assets in a participant’s individual account.
Stevens, J., delivered the opinion of the Court, in which Souter, Ginsburg, Breyer, and Alito joined. Roberts filed an opinion concurring in part and concurring [...]
Adam V. Russo | July 18, 2007
On June 18, 2007, the United States Supreme Court granted a writ of certiorari to hear the appeal of this Fourth Circuit case. Their ruling will once again affect the application of ERISA. Plaintiff (employee LaRue) alleged that the administrator had failed to invest his funds as instructed, resulting in a loss. He sought monetary [...]
Adam V. Russo | April 4, 2007
Recently, in the state of Washington, a law was passed that prohibits workplace discrimination based upon sexual orientation. When an employee protested the denial of health care coverage to her partner by her employer’s self funded ERISA plan, she brought the matter to court. The court in turn determined that the law could not be [...]
