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	<title>Passion for Subro &#187; Plan Language</title>
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	<link>http://www.passionforsubro.com</link>
	<description>The personal subrogation blog of Attorney Adam V. Russo.</description>
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		<title>Inconsistencies and Errors Not Major Enough to Violate Claims Procedure Rules or Overturn Denial</title>
		<link>http://www.passionforsubro.com/claims-procedures/inconsistencies-and-errors-not-major-enough-to-violate-claims-procedure-rules-or-overturn-denial/</link>
		<comments>http://www.passionforsubro.com/claims-procedures/inconsistencies-and-errors-not-major-enough-to-violate-claims-procedure-rules-or-overturn-denial/#comments</comments>
		<pubDate>Sun, 15 Jan 2012 22:21:25 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[California]]></category>
		<category><![CDATA[Claims Procedures]]></category>
		<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=8434</guid>
		<description><![CDATA[MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 1/12/2012, www.Thompson.com Case: Pacific Shores Hosp. v. United Behavioral Health, 2011 WL 6402435 (C.D. Calif., Dec. 19, 2011) A benefit administrator&#8217;s adverse benefit determination was imperfect but sufficient to comply with claims procedure rules, the U.S. District Court for the Central California district concluded [...]]]></description>
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		<title>Health Care Plan Summary of Benefits and Coverage: Still No Final Model, But Substantial Excise Taxes Are Looming Anyway</title>
		<link>http://www.passionforsubro.com/erisa/health-care-plan-summary-of-benefits-and-coverage-still-no-final-model-but-substantial-excise-taxes-are-looming-anyway/</link>
		<comments>http://www.passionforsubro.com/erisa/health-care-plan-summary-of-benefits-and-coverage-still-no-final-model-but-substantial-excise-taxes-are-looming-anyway/#comments</comments>
		<pubDate>Wed, 16 Nov 2011 20:05:52 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Health Care Legislation]]></category>
		<category><![CDATA[Plan Language]]></category>
		<category><![CDATA[PPACA]]></category>
		<category><![CDATA[Self-Funding]]></category>
		<category><![CDATA[Summary Plan Description]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7806</guid>
		<description><![CDATA[In our prior blog, we explained that under principles of triage, employers may need to focus on the current annual enrollment and wait to take care of the Summary of Benefits and Coverage (“SBC”). Although the SBC does not need immediate attention, we caution employers not to wait too long or take the SBC responsibilities [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Surrogate Mother Fails in Bid to Impose Definitions to Make Plan Pay for Delivery</title>
		<link>http://www.passionforsubro.com/plan-language/surrogate-mother-fails-in-bid-to-impose-definitions-to-make-plan-pay-for-delivery/</link>
		<comments>http://www.passionforsubro.com/plan-language/surrogate-mother-fails-in-bid-to-impose-definitions-to-make-plan-pay-for-delivery/#comments</comments>
		<pubDate>Fri, 04 Nov 2011 12:36:42 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Health Insurance]]></category>
		<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7690</guid>
		<description><![CDATA[www.myhealthguide.com MyHealthGuide Source: Todd Leeuwenburgh, Editor, Employer Health Benefits, Thompson Publishing Group, 6/24/2011, www.Thompson.com Case: Spectrum Health v. Lehr, No. 298688, (Mich.App., 9/8/2011) A beneficiary cannot pick definitions from various state or federal statutes and impose them on the plan where the plan left terms undefined, if the plan applies a common and ordinary meaning [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Interpreting Ambiguous Plan Language</title>
		<link>http://www.passionforsubro.com/plan-language/interpreting-ambiguous-plan-language/</link>
		<comments>http://www.passionforsubro.com/plan-language/interpreting-ambiguous-plan-language/#comments</comments>
		<pubDate>Wed, 26 Oct 2011 13:54:27 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7592</guid>
		<description><![CDATA[So half the parties interpreting a possibly ambiguous plan term that is subject to discretionary review come out one way in reading the term, and the other two the other way. Who wins? Well, this is a trick question to some extent, because it doesn’t matter the numbers – all that matters is who gets [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Claim Against Plan Administrator May Proceed Where Rule Was Left Out of Plan Language</title>
		<link>http://www.passionforsubro.com/erisa/claim-against-plan-administrator-may-proceed-where-rule-was-left-out-of-plan-language/</link>
		<comments>http://www.passionforsubro.com/erisa/claim-against-plan-administrator-may-proceed-where-rule-was-left-out-of-plan-language/#comments</comments>
		<pubDate>Tue, 30 Aug 2011 15:24:03 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Pennsylvania]]></category>
		<category><![CDATA[Plan Language]]></category>
		<category><![CDATA[Self-Funding]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=7160</guid>
		<description><![CDATA[www.myhealthguide.com  MyHealthGuide Source: Rebecca Moore, PlanSponsor, 8/25/2011, PlanSponsor Article  Case: Baker v. Pennsylvania Economy League Inc. Retirement Income Plan, E.D. Pa., No. 2:10-cv-06738-AB, 8/23/11  Editor&#8217;s Note:  While the subject of case is a pension plan, the court&#8217;s ruling against plan administrator and fiduciary breach has application for self-funded ERISA plans.  Court rules that plaintiff./ claimant  [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Amara v. Cigna: New Supreme Court Guidance on Whether Plan Document Trumps Summary Plan Description</title>
		<link>http://www.passionforsubro.com/plan-language/amara-v-cigna-new-supreme-court-guidance-on-whether-plan-document-trumps-summary-plan-description/</link>
		<comments>http://www.passionforsubro.com/plan-language/amara-v-cigna-new-supreme-court-guidance-on-whether-plan-document-trumps-summary-plan-description/#comments</comments>
		<pubDate>Tue, 07 Jun 2011 14:07:56 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Plan Language]]></category>
		<category><![CDATA[Summary Plan Description]]></category>
		<category><![CDATA[Supreme Court]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6551</guid>
		<description><![CDATA[www.orrick.com  The Supreme Court’s recent decision in CIGNA Corp. v. Amara, No. 09-804, 563 U.S. ____ (2011) has important implications for plan sponsors and those involved in benefit plan administration. In Amara, the Supreme Court held that ERISA does not grant the ability to a court to “reform” a plan to change plan terms to [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Supreme Court Signals Broader View of Equitable Relief Under ERISA</title>
		<link>http://www.passionforsubro.com/erisa/supreme-court-signals-broader-view-of-equitable-relief-under-erisa/</link>
		<comments>http://www.passionforsubro.com/erisa/supreme-court-signals-broader-view-of-equitable-relief-under-erisa/#comments</comments>
		<pubDate>Fri, 27 May 2011 01:45:01 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[ERISA]]></category>
		<category><![CDATA[Plan Language]]></category>
		<category><![CDATA[Summary Plan Description]]></category>
		<category><![CDATA[Supreme Court]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6451</guid>
		<description><![CDATA[www.healthplanlaw.com         Roy Harmon III    May 17, 2011 ·  Why the Court embarks on this peculiar path is beyond me. It cannot even be explained by an eagerness to demonstrate — by blatant dictum, if necessary — that, by George, plan members misled by an SPD will be compensated. CIGNA Corp. v. Amara, 2011 U.S. LEXIS 3540 [...]]]></description>
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		<slash:comments>0</slash:comments>
		</item>
		<item>
		<title>Estoppel Claims Can Prevail Over Unambiguous Plan Language</title>
		<link>http://www.passionforsubro.com/plan-language/estoppel-claims-can-prevail-over-unambiguous-plan-language/</link>
		<comments>http://www.passionforsubro.com/plan-language/estoppel-claims-can-prevail-over-unambiguous-plan-language/#comments</comments>
		<pubDate>Mon, 16 May 2011 14:29:25 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[6th]]></category>
		<category><![CDATA[7th]]></category>
		<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=6408</guid>
		<description><![CDATA[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. A plaintiff [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Plan Language Not A Model Of Clarity, Despite Coverage Denial Being Upheld</title>
		<link>http://www.passionforsubro.com/plan-language/plan-language-not-a-model-of-clarity-despite-coverage-denial-being-upheld/</link>
		<comments>http://www.passionforsubro.com/plan-language/plan-language-not-a-model-of-clarity-despite-coverage-denial-being-upheld/#comments</comments>
		<pubDate>Fri, 01 Apr 2011 19:54:33 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Mental Health Parity]]></category>
		<category><![CDATA[Ohio]]></category>
		<category><![CDATA[Plan Language]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=5659</guid>
		<description><![CDATA[www.hr.cch.com 3/28/11 from Spencer’s Benefits Reports: A two-month stay at a residential treatment facility for cocaine addition did not qualify for plan coverage because an acute level of care was not needed after two days, the Sixth Circuit Court of Appeals ruled in upholding the plan’s denial of benefits (Meredith Solomon v. Medical Mutual of [...]]]></description>
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		<slash:comments>0</slash:comments>
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		<title>Plan Language Supports Full Recovery From Settlement, U.S. Court Says</title>
		<link>http://www.passionforsubro.com/plan-language/plan-language-supports-full-recovery-from-settlement-u-s-court-says/</link>
		<comments>http://www.passionforsubro.com/plan-language/plan-language-supports-full-recovery-from-settlement-u-s-court-says/#comments</comments>
		<pubDate>Tue, 01 Mar 2011 15:57:57 +0000</pubDate>
		<dc:creator>cmonfils</dc:creator>
				<category><![CDATA[Plan Language]]></category>
		<category><![CDATA[Reimbursement]]></category>

		<guid isPermaLink="false">http://www.passionforsubro.com/?p=5404</guid>
		<description><![CDATA[Thompson Publishing     January 2011        Volume. 19, No. 1 Based on recent court decisions, self-insured ERISA health plans will be entitled to reimbursement of the health benefits they paid from tort settlement proceeds if the plan’s language clearly requires such a result. In addition, when a plan delegates sole discretion to the plan administrator to interpret [...]]]></description>
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