bhoffman | 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 [...]
Adam V. Russo | July 9, 2010
Like Ross, the Ninth Circuit issued a similar ruling in Standard Insurance Co. v. Morrison. Montana requires its commissioner of insurance to disapprove any [insurance] form…if the form…contains…any inconsistent, ambiguous, or misleading clauses or exceptions and conditions which deceptively affect the risk purported to be assumed in the general coverage of the contract…
Adam V. Russo | May 26, 2010
Very strange case where the plan participant never appears to defend herself against the efforts of the plan to obtain a judgment imposing a constructive trust or equitable lien against tort settlement proceeds. The case is ACS Recovery Services, Inc. v Kaplan, 2010 WL 144816 (N.D. Cal., Jan. 11, 2010)
Adam V. Russo | April 12, 2010
By Andrew Jensen Alaska Journal of Commerce
As debate raged over death panels and doctors’ fixes during the last year, a quiet battle was fought behind the scenes to preserve the ability of employers to continue paying their own health care costs.
Known as self-insurance but more accurately as self-funded plans, a substantial number of companies choose [...]
Adam V. Russo | November 18, 2009
The fact that a stop-loss insurer reimbursed a plan for some of the benefits the plan does not affect the plan’s ability to seek recovery from the participant’s tort settlement with a third-party tortfeasor. A federal court in Idaho upheld that outcome, allowing the plan to assert an equitable lien. The plan was covered by [...]
Adam V. Russo | August 28, 2009
From the August 13, 2009 EBIA Weekly
Wiley v. Cendant Corp. Short Term Disability Plan, 2009 WL 1940780 (N.D. Cal. 2009)
The employee in this case was denied disability benefits and sued his employer’s plan. In this decision affecting only the standard of review to be applied in later proceedings, the employee asked the court for the [...]
Adam V. Russo | August 11, 2009
www.plansponsor.com
The 9th U.S. Circuit Court of Appeals has affirmed a lower court’s decision that that a health plan administrator should be reimbursed for benefits it paid for a woman who was falsely represented as a participant’s legal spouse.
EBIA reports that the appellate court agreed with the U.S. District Court for the Western District of Washington [...]
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 | June 10, 2009
The court found that Sun Life failed to sufficiently allege that the particular funds to which it claims an entitlement to under the Plan’s reimbursement provision are funds belonging in good conscience to Sun Life and can clearly be traced to particular funds in plaintiff’s possession or control. Therefore the court could not impose a [...]
Adam V. Russo | May 13, 2009
The Ninth Circuit provided significant guidance for the district court to consider regarding a conflict of interest involving self-funded plans in Burke w. Pitney Bowes Inc. Long-Term Disability Plan 544 F.3d 1016 (9th Cir. 2008). While the district court ruled in favor of the plan, it reached its decision prior to the Supreme Court’s decision [...]
Adam V. Russo | May 13, 2009
The Ninth Circuit, in Daic v. Hawaii Pacific Health Group Plan for Employee of Hawaii Pacific Health, No. 06-17324, 2008 WL 3862074 (9th Cir. Aug. 13, 2008) analyzed whether MetLife, the insurer who administered the ERISA plan but was not a specifically names fiduciary, was nonetheless a plan fiduciary and whether, in light of Glenn [...]
Adam V. Russo | May 13, 2009
It’s relatively easy for a health plan to establish its right to an equitable lien against tort settlement proceeds. However, if the plan participant actually receives those proceeds and uses them for his or her own purposes, the plan will probably find it difficult to trace those proceeds.
The plan might be able to establish that [...]
Adam V. Russo | April 9, 2009
In Board of Trustees v. Hill, 2008 U.S. Dist. LEXIS 96239 (N.D. Cal. Nov. 25, 2008), the Court held that plan language establishing priority of payment – without specifically disclaiming the make whole rule – was sufficient to disclaim the concept.
Adam V. Russo | April 1, 2009
For a second time, Supreme Court Justice Anthony M. Kennedy has refused to interfere with a San Francisco local ordinance that sets minimum health benefits for workers. In a brief order, Kennedy denied an application by restaurant operators in the city to delay a Ninth Circuit Court ruling that had upheld the city ordinance on [...]
Adam V. Russo | March 31, 2009
by Amy Lynn Sorrel, AMNews staff, www.amednews.comSan Francisco’s universal health access program scored another victory in the courts in a decision that has set the stage for a possible U.S. Supreme Court showdown over the use of employer mandates as part of health system reform.
The full 9th U.S. Circuit Court of Appeals in March upheld [...]
