cmonfils | July 27, 2011
Facts:
Participant of an ERISA covered Plan had an accident and filed an action in Wisconsin wherein he named the Plan as a defendant and disputed Plan’s rights under the Made Whole Rule. Plan then filed a cross claim against defendant parties and a counter claim against member asserting made whole inapplicable due to plan language. Plan participant settled with defendant party including a surgery he consistently related to the accident and never advised plan of settlement negotiations. Subsequent to that settlement, he claimed there was an IME showing the surgery was not related to the accident. (more…)
Category: 7th, Made Whole Rule, Wisconsin |
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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
Matthiesen, Wickert & Lehrer, S.C. June 2011 Newsletter
Matthiesen, Wickert & Lehrer, S.C. (MWL) has authored and filed an amicus curiae brief on behalf of the National Association of Subrogation Professionals (NASP) in the 9 Circuit case th of CGI Technologies and Solutions, Inc. Welfare Benefit Plan v. Rhonda Rose and Nelson Langer Engle, PLLC. Ryan Woody and Tim Mentkowski authored the brief, which turned out to be a powerful defense of subrogation generally, and health insurance subrogation specifically. (more…)
Category: 9th, Legal |
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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 11, 2011
www.fordharrison.com 6/29/2011
Executive Summary: Specifically overruling the holdings of four prior decisions, a full panel of the Ninth Circuit has held that ERISA permits the beneficiaries of an employee benefits plan to sue parties other than the plan administrator to recover benefits due under the plan. See Cyr v. Reliance Standard Life Insurance Company (9th Cir. June 22, 2011). (more…)
Category: 9th, ERISA |
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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 | July 4, 2011
www.workforce.com June 27, 2011
The 9th U.S. Circuit Court of Appeals circuit court June 23 decided that retirement-plan participants can sue third-party insurers under the Employee Retirement Income (more…)
Category: 9th, ERISA |
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cmonfils | June 20, 2011
www.hrpolicy.org June 10, 2011
A survey released this week by McKinsey and Co. found that 30 percent of employers will “definitely” or “probably” stop offering employer-provided health insurance after 2014, when employer penalties and health insurance exchanges take effect under the health care reform law. In addition, the survey found that at least 30 percent of employers would benefit financially from dropping coverage even if they completely compensate employees through other benefits or higher salaries. (more…)
Category: 11th, Health Care Legislation, PPACA |
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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 | May 16, 2011
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 5/10/2011, www.thompson.com
Case: Montefiore Medical Center v. Teamsters Local 272, 2011 WL 1498823 (2nd Cir., 4/21/2011
A health provider argued that an otherwise valid assignment of benefits is a “nullity” whenever care is provided in-network. While novel, the health provider’s approach was unsuccessful in trying to avoid ERISA preemption of its state-law claims against an employer plan. (more…)
Category: 2nd, ERISA, PPOs |
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cmonfils | May 9, 2011
www.myhealthguide.com
MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 5/4/2011, www.thompson.com
Case: Hansen v. Harper Excavating, 2011 WL 1379821 (10th Cir., April 13, 2011)
Fine distinctions about an employee’s status as a non-ERISA beneficiary allowed his state-law case — even though he had already prevailed on an ERISA complaint based on closely related facts — to survive, a U.S. appeals court has ruled in the above case. (more…)
Category: 10th, ERISA, Preemption |
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cmonfils | May 5, 2011
www.erisalawyerblog.com
May 3, 2011 By Stanley D. Baum May 3, 2011
In Redeaux v. Southern National Life Insurance Company, No. 10-30670 (5th Cir. 2011), the Court faced the question of whether an accidental death benefit was payable from a plan subject to ERISA (the “Plan”). (more…)
Category: 5th, Exclusion |
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