Adam V. Russo | July 9, 2010

This unanimous decision resolved a split in the lower courts over a fact pattern regularly faced by administrators of ERISA plans when an employee and spouse are divorced, but the employee dies before changing the beneficiary designation for benefits. In Kennedy, the Supreme Court held that, notwithstanding the contrary terms of a divorce decree, the former spouse was entitled to receive payment from the plan because the divorce decree could not overcome the express terms of a plan document. (more…)

Category: ERISA, Preemption, Summary Plan Description, Supreme Court | No Comments »
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Adam V. Russo | April 27, 2010

In Hall v. Newmarket Corp, Aetna Life Insurance Co., et al. ___F.2d___(D.C. MS. 2009), Theresa Hall was covered through her employer, Newmarket, under a self funded arrangement that was administered by Aetna. When her plant closed down she continued coverage through Aetna and paid premiums to Aetna from 2001 to 2004, when she switched over to Blue Cross Clue Shield. (more…)

Category: ERISA, Mississippi, Preemption | No Comments »
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Adam V. Russo | April 20, 2010

Plaintiffs argue that Medical Mutual, in its processing of insurance claims, violated the federal RICO statute. Specifically, Plaintiffs allege that Medical Mutual “acted to delay, diminish and deny payment of . . . lawful claims of patient-insureds as submitted by out-of-network health providers . . . through a scheme or artifice, utilizing the U.S. Mail and demonstrating a specific intent to defraud the patient-insureds and out-of-network health-care providers.” (Compl. P 51.). . . . (more…)

Category: Health Care Legislation, Preemption | No Comments »
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Adam V. Russo | January 29, 2010

The Boeing Company v. Thurmon, No. 4:09-cv-1456, in the United States District Court for the Eastern District of Missouri, December 7, 2009. This is a subrogation case, significant for its fresh and express reiteration of the bedrock proposition that purchase of stop loss insurance by the sponsor of a self-insured employee benefit plan does not affect pre-emption analysis. In other words, a self-insured plan is still a self-insured plan, despite the existence of excess loss coverage. (more…)

Category: Missouri, Preemption, Stop Loss | No Comments »
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Adam V. Russo | December 8, 2009

An employee’s spouse sued the insurer of her cancer insurance policy in state court after it refused to pay for medical treatment she had received. The insurer removed the case to federal court, arguing that her claim was preempted by ERISA. The spouse argued that the case belonged in state court because the policy fit within the regulatory safe harbor that excepts from ERISA certain voluntary insurance arrangements. At issue was whether the policy, which was offered through a cafeteria plan, fell outside the voluntary plan safe harbor because the employer had endorsed it. (more…)

Category: 11th, ERISA, Preemption | No Comments »
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Adam V. Russo | November 18, 2009

By Stanley D. Baum – Erisalawyerblog.com

In Hitachi High Technologies America, Inc. v. Bowler, SJC-10386 (Supreme Judicial Court of Massachusetts 2009), the Court faced the question of whether ERISA preempts a State law action brought by a retirement plan fiduciary to recover money mistakenly paid to a plan participant. In this case, the plaintiff, Hitachi High Technologies America, Inc. (Hitachi), filed an action for unjust enrichment in the Mass. Superior Court against its former employee, the defendant Kevin Bowler, for his alleged failure to reimburse $29,315.75, with interest, in retirement benefits that Hitachi had overpaid to Bowler due to an accounting error. The lower court dismissed the case on the grounds that it lacked subject matter jurisdiction. (more…)

Category: ERISA, Massachusetts, Preemption | No Comments »
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Adam V. Russo | June 24, 2009

by John H. Eggertsen, Esq. and Michael Friedman, Esq. of SIIA, www.siia.org

I. District of Columbia’s Efforts to Regulate PBMs Preempted by ERISA
In their efforts to combat the ongoing initiatives on the part of several states to regulate the business activities of pharmacy benefit managers (“PBMs”), the PBMs recently won a skirmish. In Pharmaceutical Care Management Association v. District of Columbia, et al. 2009 WL 711771 (D.C.D.C.), a Federal District Court for the District of Columbia held that by regulating the relationship between PBMs and ERISA plans, the District of Columbia’s Access Rx Act of 2004 (the “Act”) “impermissibly intrudes upon a field exclusively reserved for federal regulation,” and thus, is preempted under ERISA. (more…)

Category: 1st, ERISA, Maine, Preemption, Washington D.C. | No Comments »
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Adam V. Russo | June 10, 2009

In American Council of Life Insurers v. Ross, case, 2009 U.S. App. LEXIS 5748,F.3d (6th Cir. 2009), the Sixth Circuit held that a Michigan law prohibiting insurers from including discretionary language in insurance policies fell within the scope of ERISA preemption “savings clause” and was therefore enforceable. The court relied on the Supreme Court’s Miller decision, which articulated a new test for determining whether a state law “regulates insurance” and is, therefore, saved from ERISA preemption. Applying the Miller test, the Sixth Circuit held that this particular law regulated insurance because it directly controlled the terms of insurance contracts by prohibiting insurers and insureds from entering into contracts having discretionary language.The case is particularly noteworthy because the court cites the Glenn case in support of its decision that the state law should not be preempted. The Court stated that Glenn provides further support for holding that Michigan’s law is not preempted by ERISA. The Court reiterated that a conflict of interest exists when the same insurer is responsible for examining and paying a benefits claim. (more…)

Category: 6th, ERISA, Preemption | No Comments »
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Adam V. Russo | May 13, 2009

In Edward Marram as Trustee of the Geo-Centers, Inc. Profit Sharing Plan & Trust v. Kobrick Offshore Fund, Ltd. et al., 2009 Mass. Super. LEXIS 85, a state trial judge wrote extensively on ERISA preemption – something that is extremely rare. (more…)

Category: ERISA, Preemption | No Comments »
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Adam V. Russo | October 29, 2008

Thanks to the Self-Insurance Institute of America, Inc. (SIIA) for bringing this news to our attention.  It seems that a “model law” has been drafted by the National Conference of Insurance Legislators, with the purpose of ratification by member States in mind.

The law addresses concerns over PPO rental networks; situations where PPO networks negotiate discounts with non-payer, third party entities (such as third party administrators).  (more…)

Category: ERISA, Preemption, Third Party Administrators | No Comments »
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Adam V. Russo | October 28, 2008

You may have heard of the case Benefit Recovery, Inc. v. Donelon, et al., 521 F.3d 326 (5th Cir. 2008); F.3d 2008 WL 642972 (5th Cir. La.), 43 Employee Benefits Cas. 1417.  It was likely brought to your attention by someone claiming there is a made whole rule in Louisiana that binds even self-funded employee benefit plans, coming within the purview of ERISA.  This is simply not the case. (more…)

Category: ERISA, Louisiana, Made Whole Rule, Preemption | No Comments »
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Adam V. Russo | October 3, 2008

The parents of a minor child sued their health plan insurer when it denied their daughter’s claims for benefits.  The parents argued that the insurer failed to comply with a state external review law for insurers, which required an independent review process for denied claims. The insurer asked the court to dismiss the claim, arguing that the state external review law was preempted by ERISA. (more…)

Category: 9th, ERISA, Preemption | No Comments »
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Adam V. Russo | August 15, 2008

ERISA preempted an Illinois state law outlawing any claim on a workers’ compensation award, because the law related to benefits plans regulated by ERISA, a federal trial court decided. As a result, an employer may seek reimbursement of group health plan funds from workers’ compensation awards. The health plan paid the expenses before a determination was made that the claims were work related. The court determined that the settlements included reimbursement for health expenses that were paid by the plan. At least one of the awards was worded to assert that it was not a payment for health benefits, but the judge said that was an effort to stop a recovery attempt. (more…)

Category: 7th, ERISA, Illinois, Preemption | 1 Comment »
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Adam V. Russo | July 14, 2008

In the matter of Sgro v. Danone Waters of North America, Inc., 2008 U.S. App. LEXIS 13973 (9th Cir. Jul. 2, 2008), an employee – Mitchell Sgro – applied for benefits from his employer’s ERISA Plan.  He incurred $412.00 in copying fees, in the process of supplying documentation and medical records to his employer as part of his claim. (more…)

Category: 9th, California, Preemption | No Comments »
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Adam V. Russo | July 1, 2008

Many involved in the administration of ERISA Plans do not realize that some state insurance law is preempted even when a fully insured ERISA Plan is involved.

In Spellman  v. United Parcel Service, 540 F. Supp.2d 237 (D.C. Maine 2008), the Court addressed an issue of enforcing Maine’s  workers’ compensation statutes with regards to health plans under ERISA. (more…)

Category: Maine, Preemption, Summary Plan Description | No Comments »
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