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 |
No Comments »
Tags:
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… (more…)
Category: 9th, Preemption, Summary Plan Description |
No Comments »
Tags:
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) (more…)
Category: 9th, California, Federal Circuits, Subrogation |
No Comments »
Tags:
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 to pay their employee health care expenses directly out of their own general funds rather than buy a group plan from a private insurance company. (more…)
Category: 9th, ERISA, Health Care Legislation |
No Comments »
Tags:
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 a stop-loss policy with a $50,000 stop-loss trigger. The participant incurred nearly $125,000 in health expenses and the plan received nearly $75,000 from the stop-loss insurer. The plan sought assets from the settlement. Clear plan provisions stated it had a right to the settlement funds. The court rejected arguments that stop-loss insurance makes a self-funded employee benefit plan insured for the purpose of ERISA preemption. The court concluded that the participant signed away her right to invoke the make-whole rule, because the plan specifically provided that it was entitled to reimbursement of the benefits paid even if the plan participant was not made whole. (more…)
Category: 9th, ERISA, Stop Loss |
No Comments »
Tags:
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 that the $70,000 reimbursement is considered equitable relief under the Employee Retirement Income Security Act (ERISA). The courts rejected Ralph W. Cutter’s argument that because the benefits were not paid directly to him and were not in his possession, the plan could not seek reimbursement from him. (more…)
Category: 9th, Welfare Benefit Plans |
No Comments »
Tags:
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 employees. (more…)
Category: 4th, 9th, California, Maryland |
No Comments »
Tags:
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 constructive trust or equitable lien on such funds. In this case, the district court held that the claim for reimbursement did not adequately allege equitable relief. (more…)
Category: 9th, Subrogation |
No Comments »
Tags:
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 in Glenn. The Ninth Circuit therefore remanded the matter for the district court to consider the potential conflict of interest in light of Glenn. In doing so, the court rejected the proposition that a structural conflict of interest cannot exist where a plan is self-funded, with benefits paid out of trust. The court held that even when benefits are paid out of a trust, instead of directly by an employer, the employer has a financial incentive to deny claims because every dollar not paid in benefits is a dollar that will not need to be contributed to fund the Trust. The court explained: “although there is no dollar-for-dollar correlation, it still remains true that the more that the Trust pays out in benefits, the more the plan must contribute to maintain the Trust’s solvency.”
Category: 9th, Conflict of Interest |
No Comments »
Tags:
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 the district court erred by inadequately considering MetLife’s structural conflict of interest. (more…)
Category: 11th, 9th, MetLife v. Glenn |
No Comments »
Tags:
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 a specific asset, such as a home might be subject to a constructive trust in favor of the plan. However, taking possession of such an asset and liquidating it will be problematic. (more…)
Category: 9th, Subrogation |
No Comments »
Tags:
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. (more…)
Category: 9th, Made Whole Rule |
No Comments »
Tags:
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 mandated health spending. The Justice acted without issuing an opinion in Golden Gate Restaurant Association v. San Francisco.
Category: 9th |
No Comments »
Tags:
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 an earlier decision by a panel of three of its judges validating the city program’s employer spending provision. The provision requires businesses to contribute a minimum amount toward workers’ health coverage or pitch in to a city fund for Healthy San Francisco, a universal access program offering primary and preventive care to uninsured residents. (more…)
Category: 9th |
No Comments »
Tags:
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 the Sixth Circuit’s determination in that case was affirmed by the Supreme Court. The Sixth Circuit affirmed the district court’s decision that the claim administrator’s denial of benefits was not arbitrary. (more…)
Category: 11th, 4th, 6th, 9th |
No Comments »
Tags:
