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 [...]
bhoffman | August 27, 2010
Employer’s Guide to Self-Insuring Health Benefits, Thompson Publishing Group
Employers and other plan administrators are due greater deference in their benefits plan decisions than some lower courts have allowed, the U.S. Supreme Court ruled after admonishing two lower courts for failing to follow the High Court’s prior decisions establishing ERISA law on plan administration.
The High Court [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Victims of accidents in subrogation/reimbursement cases have emotional appeal when they argue that tort settlements are reduced without some consideration of the fact that they were not “made whole” or had their recoveries diminished by not requiring a recovering plan to share the legal fees they incurred in making the settlement. There [...]
bhoffman | August 25, 2010
Coordination of Benefits Handbook
Although federal case law is well settled on the principle that an ERISA health plan is entitled to reimbursement of benefits paid from tort settlement proceeds that are clearly identified as such, it appears that attorneys for plan participants still come up with several arguments seeking to avoid such liability. Those arguments [...]
bhoffman | August 5, 2010
Tuesday, August 3rd, I had the pleasure of speaking at the 2010 TriZetto Benefits Administration Client Conference held at the Sheraton Chicago Hotel & Towers in Chicago, IL.
Click here to see my entire PowerPoint presentation on “Innovative Plan Document Strategies”.
bhoffman | July 19, 2010
www.seethebenefits.com
There is a well-known saying among baseball fans that the “tie goes to the runner.” This is true under one baseball rule that provides that a batter is out if he or the base is tagged before he reaches first. It is not true, however, under another rule that provides that a runner is out [...]
Adam V. Russo | July 9, 2010
This year, while the Sixth Circuit held that an illegal act exclusion could not be applied because of a lack of causation between the illegal act and the injuries for which benefits were sought, an Indiana district court found that an administrator’s decision to deny health benefits based on a plan exclusion was “not reasonable” [...]
Adam V. Russo | July 9, 2010
This year’s lone felony/intoxication case raises an interesting question: when is driving under the influence a felony? In Kay-Woods v. Minnesota Life Insurance Co.,13 the insured died in a single-vehicle accident while driving with a revoked license and under the influence of alcohol and cocaine. The policy provided that benefits would not be paid if [...]
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 | July 9, 2010
Defendant-appellee Ken Ross is the commissioner of the Michigan Office of Financial and Insurance Services (OFIS). OFIS is responsible for licensing, examining, and supervising insurers and nonprofit health care corporations doing business in Michigan. To this end, OFIS’s authority includes the power to disapprove insurance policy forms and documents associated with such forms that are [...]
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 [...]
Adam V. Russo | June 28, 2010
www.healthplanlaw.com
Here, there are no terms in the plan which allow it to be amended by inserting into the SPD such critical provisions as the administrator’s discretionary authority to interpret the plan or to determine eligibility for benefits. Indeed, this particular plan wholly fails to comply with § 1102(b)(3)’s requirement to include a procedure governing amendment [...]
Adam V. Russo | June 21, 2010
www.plansponsor.com
June 8, 2010 (PLANSPONSOR.com) – The U.S. District Court for the Western District of Wisconsin has found that an employer did not breach its fiduciary duties by failing to inform a former employee and his wife about all of their benefit options.
Adam V. Russo | May 12, 2010
From the April 29, 2010 EBIA Weekly
The participant in this case was denied benefits under her employer’s LTD plan and sued the plan’s insurer. The trial court applied an abuse of discretion standard—which requires a court to defer to the administrative decision unless that decision is unreasonable—and upheld the denial of benefits. The participant appealed, [...]
Adam V. Russo | March 23, 2010
From The Bench By John H. Eggertsen, Esq. and Michael Friedman, Esq.
As health care costs continue to rise, and employers become more vigilant about policing benefit costs, it is perhaps inevitable that lawsuits by employers against their plan’s TPA are likely to increase. A recent such case, W.E. Aubuchon Company, inc. v. BeneFirst, LLC, 2009 [...]
