cmonfils | January 10, 2012
In order to support a valid claim of retaliation under the Family and Medical Leave Act (FMLA), an employee must demonstrate that the reason given for an adverse employment action was pretextual, and that the employee’s request for or use of FMLA leave was the actual basis of the action. The 6th U.S. Circuit Court of Appeals has held that an employer’s rejection of an invalid FMLA certification was a valid reason for termination, and that the employee’s inability to proffer evidence of an alternate explanation for the company’s actions led to the dismissal of her lawsuit. Coffman v. Ford Motor Company, 6th Cir., No. 10-3842, unpublished opinion, 11/22/11.
Category: 6th, FMLA |
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cmonfils | January 3, 2012
Employer’s Guide to Self-Insuring Health Benefits December 2011 | Vol. 19, No.3
The attempted treatment of stop-loss coverage as “health insurance” subject to state insurance law has been a thorn in the sides of self-funded plans seeking to maintain ERISA preemption of state insurance laws.
In Goyen v. Vail Corp., 2011 WL 4479091 (D. Colo., Sept. 26, 2011), a federal district court rejected a plaintiff’s argument that a plan stopped being self-funded and lost ERISA preemption, all because it had taken out a stop-loss policy. (more…)
Category: 3rd, 6th, ERISA, Preemption, Self-Funding, Stop Loss |
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cmonfils | November 18, 2011
Is the Affordable Care Act constitutional or not?
It seems like every week brings a different wrinkle, if not a new answer.
The Supreme Court will convene on Thursday to decide whether to take up the case against reform. The universal expectation is that the high court will elect to grant certiorari, rather than avoid the lawsuits altogether.
Category: 11th, 4th, 6th, Health Care Legislation |
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cmonfils | September 19, 2011
Coordination of Benefits
Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
A recent decision by a U.S. appeals court upheld a recovery in which a plan dealt directly with the auto liability insurer to achieve a recovery. The case is Shaffer v. Rawlings Co., 2011 WL 1977252 (6th Cir., May 18, 2011). (more…)
Category: 6th, Reimbursement |
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cmonfils | September 9, 2011
Sep 08, 2011
The Virginia case, brought by state Attorney General Ken Cuccinelli, was considered one of the highest profile health law challenges to the health law. In its opinion, issued today, the appellate court ruled that the state does not have standing to challenge the law’s individual mandate because it lacks “a personal stake.” It also concluded that Liberty University’s challenge should be dismissed. (more…)
Category: 11th, 4th, 6th, Health Care Legislation, Virginia |
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cmonfils | August 22, 2011
Coordination of Benefits Employee Benefits Series THOMPSON July 2011 | VOL. 19, No.3
Legal Brief
A recent decision by a U.S. appeals court upheld a recovery in which a plan dealt directly with the auto liability insurer to achieve a recovery. The case is Shaffer v. Rawlings Co., 2011 WL 1977252 (6th Cir., May 18, 2011). (more…)
Category: 6th, ERISA, Reimbursement |
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cmonfils | August 22, 2011
www.myhealthguide.com
MyHealthGuide Source: Thomas Croft, Esq., King & Croft LLP, 8/17/2011, www.StopLossLaw.com
Case: Bekaert Corp. v. Standard Security Life Ins. Co of New York., No.5:09CV2903, in the United States District Court for the Northern District of Ohio, 8/15/2011. Court’s Opinion.
Mr. Croft’s Comment: This is the second federal decision rejecting a group’s unreasonable interpretation of its own Plan language in just over a month. Clarcor, Inc. v. Madison National Life Ins. Co. was the first. One can be hopeful that a trend is emerging, and that decisions like Diversatek, Inc. v. QBE Ins. Corp. will be shown to be the outliers that they are. (more…)
Category: 6th, Stop Loss |
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cmonfils | July 18, 2011
www.myhealthguide.com
MyHealthGuide Source: Thomas Croft, Esq., King & Croft LLP, 7/15/2011, www.StopLossLaw.com
Case: Clarcor, Inc. v. Madison National Life Ins. Co., No. 3:10-189, in the United States District Court for the Middle District of Tennessee, July 11, 2011). Court’s Opinion.
CComment by Mr. Croft: The Court got this one right. Clarcor sued Madison National, the stop loss carrier, claiming that certain expenses paid by its Plan for the medical care of one of Clarcor’s employees were reimbursable under the stop loss contract. The employee, identified in the Court’s opinion only as “I.K.,” was last “regularly scheduled” to work on October 20, 2007. She elected FMLA, which preserved her eligibility through January 12, 2008. At the end of the FMLA period, I.K. was not offered COBRA, but was instead placed on “short-term disability” until June 23, 2008 when she was terminated and offered COBRA. Although not discussed in the Court’s opinion except in an oblique footnote, the Madison National stop loss policy appears to have had a “late COBRA” exclusion, based on a review of the parties’ briefing. (more…)
Category: 6th, Stop Loss |
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cmonfils | July 15, 2011
www.hrpolicy.org July 8, 2011
In the first decision from a federal appeals court on the health care reform law, the Sixth Circuit concluded that the individual mandate in the health care reform law is constitutional. The ruling in Thomas More Law Center v. Obama came as no surprise, given the judges’ expressed skepticism during oral arguments. (more…)
Category: 6th, PPACA |
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cmonfils | July 11, 2011
www.businessinsurance.com July 4 & 11, 2011
IS THE HEALTH CARE reform law constitutional?
That’s the question courts have faced since Congress passed the Patient Protection and Affordable Care Act and President Barack Obama signed it into law last year.
In the highest-level court decision so far, the 6th U.S. Circuit Court of Appeals ruled last week that a key provision in the law is constitutional. The provision requires U.S. residents to enroll in a qualified health plan starting in 2014 or pay a fine. (more…)
Category: 6th, Health Care Legislation |
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cmonfils | July 11, 2011
www.modernhealthcare.com By Neil McLaughlin July 4, 2011
Notes on the news:
Healthcare reform proponents were gleeful about last week’s federal appeals court decision upholding the Patient Protection and Affordable Care Act. Given current conditions, they should hold off on popping the Champagne corks. (more…)
Category: 6th, Health Care Legislation, Health Insurance, Medicare |
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cmonfils | July 11, 2011
www.ebia.com From the June 30, 2011 EBIA Weekly
[Thomas More Law Ctr. v. Obama, 2011 WL 2556039 (6th Cir. 2011)]
Available at http://www.ca6.uscourts.gov/opinions.pdf/11a0168p-06.pdf
In the first Court of Appeals decision to address the issue, the Sixth Circuit has upheld the constitutionality of the individual mandate provisions of health care reform (which require most individuals to have health coverage beginning January 1, 2014 or pay a penalty). (more…)
Category: 6th, Health Care Legislation |
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cmonfils | July 4, 2011
www.nytimes.com Published: June 29, 2011 Kevin Sack
The Obama administration prevailed Wednesday in the first appellate review of the 2010 health care law as a three-judge panel from the United States Court of Appeals for the Sixth Circuit held that it was constitutional for Congress to require that Americans buy health insurance. (more…)
Category: 6th, Health Care Legislation |
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cmonfils | May 16, 2011
www.healthplanlaw.com Roy Harmon III May 12, 2011
Defendants argue that the first amended complaint is deficient because, with the exception of Count Four, which is identified as a claim for benefits pursuant to §1132(a)(1)(B), plaintiff fails to specify the ERISA statutory provisions upon which her claims are based. This argument is not well taken. (more…)
Category: 6th, 7th, Plan Language |
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cmonfils | April 11, 2011
www.myhealthguide.com
MyHealthGuide Source: John Eggertsen, Esq., Eggertsen Consulting, P.C., www.jhelaw.com
The U.S. Court of Appeals for the Sixth Circuit April 6 reversed an injunction that required Blue Cross Blue Shield of Michigan (BCBSM) to provide a multiemployer health fund with documents detailing BCBSM’s discount arrangements with medical providers (Pipefitters Local 636 Insurance Fund v. Blue Cross & Blue Shield of Michigan, 6th Cir., No. 09-2294, unpublished 4/6/11). (more…)
Category: 6th |
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