Adam V. Russo | July 9, 2010
In addressing the contents of the administrative record that must be disclosed to a claimant, the court in Mondry v. American Family Mutual Insurance Co. concluded that a claim administrator’s internal documents and guidelines could be subject to mandatory production in ERISA cases if the claims administrator expressly cites to such documents and equates them [...]
Adam V. Russo | July 9, 2010
Juli Pollitt, a federal employee, had health insurance administered by Health Care Service Corp. (HCSC). In July 2007, HCSC stopped paying claims submitted on behalf of Pollitt’s son Michael and began trying to collect from health care providers any payments made on Michael’s behalf since 2003. According to HCSC, it did this because the Department [...]
Adam V. Russo | June 21, 2010
www.plansponsor.com
June 8, 2010 (PLANSPONSOR.com) – The U.S. District Court for the Western District of Wisconsin has found that an employer did not breach its fiduciary duties by failing to inform a former employee and his wife about all of their benefit options.
Adam V. Russo | January 4, 2010
In Majeski v. Metropolitan Life Insurance Co., No. 09-1930 (7th Cir. 2009), the plaintiff, Kirsten Majeski, had been employed by Metropolitan Life Insurance Company (“MetLife”), and had participated in MetLife’s Short Term Disability Plan (the “Plan”).
The case centers on the decision of MetLife, as plan administrator, to reject Majeski’s claim for short-term disability benefits, after [...]
Adam V. Russo | November 18, 2009
When it is clear that the tort settlement proceeds are held in a separate account and the plan clearly provides for 100-percent reimbursement, the fact that the plan beneficiary is a minor child will not preclude the plan’s entitlement to reimbursement. The case is Iowa Health System, Inc. v. Graham, 2009 WL 2222780 (C.D. Ill., [...]
Adam V. Russo | November 18, 2009
Plan’s subrogation and reimbursement language may actually thwart their ability to recover from tort settlement proceeds benefits they paid. It is important for plan language to ensure that its recovery claim is limited to settlement proceeds. In one such case, a health plan did not identify a particular fund from which the reimbursement should be [...]
Adam V. Russo | November 18, 2009
By Stanley D. Baum – Erisalawyerblog.com
In Wetzler v. Illinois CPA Society & Foundation Retirement Income Plan, No. 08-2923 (7th Cir. 2009), the plaintiff, Thomas Wetzler, wanted a lump-sum payment of his entire retirement benefit from the Illinois CPA Society & Foundation Retirement Income Plan (the “Plan”). The Plan is a tax-qualified defined benefit pension plan. [...]
Adam V. Russo | August 28, 2009
From the August 20, 2009 EBIA Weekly[Fischer v. Liberty Life Assurance Co. of Boston, 2009 WL 2366115 (7th Cir. 2009); Raybourne v. Cigna Life Ins. Co. of N.Y., 2009 WL 2392788 (7th Cir. 2009)]
The Seventh Circuit has decided a pair of LTD benefit cases that consider the impact of the U.S. Supreme Court’s Glenn decision. [...]
Adam V. Russo | August 19, 2009
The number of cases that apply the Supreme Court’s opinion in Metropolitan Life Insurance Company v. Glenn, 128 S. Ct. 2343 (2008) , when reviewing a decision to deny employee benefits by an administrator with a conflict of interest, continue to grow. The most recent example is Raybourne v. Cigna Life Insurance Company of New [...]
Adam V. Russo | July 28, 2009
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 [...]
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 26, 2009
Anderson v. Dergance, 2009 U.S. Dist. LEXIS 51593 (N.D. Ill. June 18, 2009)
This ERISA plan reimbursement case applies the Sereboff holding to find in favor of an ERISA plan’s claims to specifically identifiable funds held in an attorney’s trust account following a personal injury settlement.
Adam V. Russo | May 28, 2009
by Fred Schneyer of PLANSPONSOR, www.plansponsor.com
An Indiana manufacturer has received a mixed ruling from a federal judge in a lawsuit alleging its misdeeds in the handling of its benefits program constituted a fiduciary breach.
Adam V. Russo | April 23, 2009
Sharon Mondry worked for American Family and sought payment for speech therapy for her son from her self-funded health plan sponsored by American Family and administrated by the CIGNA the TPA. CIGNA denied payment fro Zev Mondry’s speech therapy on the basis that it was educational training and not restorative pursuant to the terms of [...]
Adam V. Russo | November 11, 2008
Most lawsuits to recover damages in car accidents are resolved in state courts. State courts will order that at least a portion of the judgment be deposited into court when it appears that a health plan may have the right to reimbursement. But can a state court override the right of the health plan to [...]
