cmonfils | November 29, 2011
THIRD CIRCUIT HOLDS THAT ERISA PLANS REIMBURSEMENT CLAIMS ARE SUBJECT TO EQUITABLE DEFENSES AND LIMITATIONS
On November 16, 2011, the Third Circuit held in US Airways, Inc. v. McCutchen, that an ERISA plan’s claims for reimbursement under ERISA §502(a)(3) are subject to equitable limitations and defenses. The matter involved a self-funded ERISA plan which had paid $66,866 on behalf of a plan participant who was injured in an automobile accident. (more…)
Category: 11th, 3rd, 8th, 9th, ERISA, Reimbursement |
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cmonfils | October 18, 2011
www.benefitlink.com
(From the October 10, 2011 issue of Deloitte‘s Washington Bulletin, a periodic update of legal and regulatory developments relating to Employee Benefits.)
A recent Eighth Circuit Court of Appeals case illustrates the complexity of determining whether an employment agreement is an ERISA plan, and the impact of that decision on the employee’s ability to bring suit. In a case of first impression for the Eighth Circuit, the Court ruled that as matter of law a one-person, individually-negotiated employment agreement is not an ERISA plan. (more…)
Category: 8th, ERISA |
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cmonfils | September 28, 2011
www.uslf.practicallaw.com
Resource type: Legal Update: Archive
Status: Published on 15-Aug-2011
Jurisdiction: USA
In Dakota, Minnesota & Eastern Railroad Corporation v. Schieffer, the US Court of Appeals for the Eighth Circuit ruled that a one-person employment contract is not a plan under the Employee Retirement Income Security Act (ERISA). However, the court held that a federal court may still have jurisdiction over portions of the complaint and remanded the case with instructions for addressing ERISA preemption. (more…)
Category: 8th, ERISA |
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cmonfils | March 10, 2011
www.healthplanlaw.com March 4, 2011 •
“ . . . [I]n order for Principal to reasonably deny S.W.’s hospital charges, substantial evidence had to support its determination that the primary focus of her hospitalization was mental health treatment, i.e., treatment designed to alter her behavior. While there is certainly evidence that mental health treatment was one focus of S.W.’s hospitalization, we conclude there is insufficient evidence to support the determination that S.W.’s mental health was the primary focus of the hospitalization.“ (more…)
Category: 8th, Mental Health Parity |
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cmonfils | March 1, 2011
www.healthplanlaw.com
February 21, 2011 • Roy Harmon III
In Comrie v. IPSCO (7th. Cir. 2/18/11) the Seventh Circuit considered whether a discretion-conferring clause in a SERP plan document should be applied when the plan administrator is not a fiduciary. Noting a difference of opinion on the issue, the Seventh Circuit, via Judge Easterbrook, saw the issue as very simple to resolve: (more…)
Category: 7th, 8th, ERISA |
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Adam V. Russo | September 7, 2010
Summary
State appeals court in Missouri affirms trial court ruling — Scroggins was injured in a trip-and-fall at a R.Lobster. Her employer’s (St. John’s Hospital, a subsidiary of Sisters of Mercy) self-funded plan covered her health expenses. Also, she sued the restaurant and extracted a settlement. The plan had subro clause up to the full amount it paid in expenses. The trial court refused to enforce the lien (it was a veiled partial assignment of her personal injury claim, and contrary to Missouri public policy). The plan was not subject to ERISA, because of its religious non-profit affiliation made it a church plan. Accordingly, the appeals court upholds state public policy, noting (a) that tort settlement is for pain and suffering, which is not to be a marketable commodity; (2) the plan had no separate claim against the tortfeasor; cases where liens were allowed in personal injury claims involved payers that claims against tortfeasor.
Click here to see the entire case
Category: 8th, Missouri, Subrogation, Welfare Benefit Plans |
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Adam V. Russo | September 1, 2010
SIIA, www.siia.org
By Thomas A. Croft, Esq.
I. The Supreme Court Clarifies ERISA Attorney Fee Provision
We have two reasons for reviewing Hardt v. Reliance Standard Life Ins. Co., 130 S. Ct. 2149 (2010). First, it is the latest ERISA decision from the Supreme Court cases define ERISA jurisprudence, they cannot be ignored. Second, the case addresses an issue near and dear to our hearts – attorneys’ fees.
On its facts, Hardt is something of a plain vanilla disability case. Hardt was an executive assistant to the president of Dan River, Inc., a textile manufacturer. After being diagnosed with carpal tunnel syndrome, Hardt applied for long term disability (“LTD”) benefits. Her claim was denied by Reliance Standard Life Insurance Company (“Reliance”), Dan Rivers’ LTD insurer. On appeal, Reliance reversed itself in part and determined that Hardt was totally disabled from performing her current job, thus entitling her to 24 months of coverage. (more…)
Category: 8th, 9th, Attorneys' Fees, ERISA, Fiduciary, Summary Plan Description, Supreme Court |
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Adam V. Russo | July 9, 2010
The special administrator of the estate of a deceased employee, who was an ERISA plan participant, brought action against the employee’s former employer for breach of fiduciary duty seeking to recover the amount of the employee’s life insurance coverage before his first medical leave of absence, which lapsed when the employee was terminated without notice. (more…)
Category: 8th, ERISA |
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Adam V. Russo | July 9, 2010
Sandra Chronister was employed as a nurse at Baptist Health in Arkansas. In 1995, she was injured in a car accident, and thereafter sought disability benefits under Baptist Health’s long-term disability plan, which was insured and administered by Unum Life Insurance Co. of America. Unum initially granted her application for disability benefits. At Unum’s urging, Chronister also applied for, and received, social security disability benefits. After twenty-four months, however, Unum informed Chronister that it was terminating her benefits under the “self-reported symptoms” limitation of the plan. Chronister exhausted her administrative remedies and then brought suit. The Eastern District of Arkansas ultimately determined that substantial evidence did not support Unum’s decision to deny Chronister benefits based on the self-reported symptoms limitation. The district court remanded the matter to Unum with directions to reopen the administrative record and make a new determination. (more…)
Category: 8th, Conflict of Interest, MetLife v. Glenn, Standings |
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Adam V. Russo | January 25, 2010
This is a huge win for the subrogation industry.
The court held that Sereboff, rather than Knudson, controlled in this case. Like in Sereboff, the Plan targeted specific funds for recovery , Cusson’s LTD payments, and identified the specific portion to which Liberty is entitled— the amount of the overpayment while Cusson was receiving benefits under the LTD Plan. (more…)
Category: 1st, 8th, ERISA |
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Adam V. Russo | August 4, 2009
In Iowa Health Systems v. Graham, 2009 U.S. Dist. LEXIS 63544 (C.D. Ill. July 23, 2009), Iowa Health wants the Court to impose a constructive trust or equitable lien over a portion of specifically identifiable funds over which Graham has possession. (more…)
Category: 8th, ERISA, Health Care Legislation, Subrogation |
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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 written health plan. Reversing summary judgment for the participant, the Eighth Circuit held that the plan administrator reasonably construed the SPD to be on the plan document for purposes of a group health plan in the absence of any formal plan and that the reimbursement provision in the SPD was therefore enforceable. (more…)
Category: 10th, 7th, 8th, Fiduciary Liability, Plan Language, Summary Plan Description |
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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 Glenn, the Supreme Court held that a decision maker’s conflict of interest does not change the standard of review, but must be considered as a factor when applying the abuse of discretion standard. (more…)
Category: 3rd, 8th, MetLife v. Glenn |
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Adam V. Russo | January 16, 2009
The Supreme Court’s opinion in Black & Decker Disability Plan v. Nord, 538 U.S. 822(2003) did not hold that treating physician opinions can be neglected. This recent Eighth Circuit opinion demonstrates an application of an important piece of the Nord decision – that the administrator must take into account treating physicians’ opinions in reaching its conclusions. (more…)
Category: 8th |
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Adam V. Russo | November 11, 2008
The U.S. District Court in North Dakota recently sorted out conflicting COB provisions of motor vehicle and health coverage. The court ruled that the motor vehicle policy had to pay its maximum benefits before the health plan began paying its benefits. In the North Dakota case, an auto policy restricted benefits to $5,000 in the event the policyholder is covered by another policy; the health plan mandated that the auto insurer must pay up to its policy limit before the plan would begin paying. The court upheld the health plan’s decision. (more…)
Category: 8th, North Dakota |
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