cmonfils | May 26, 2011
www.haynesboone.com 05/24/2011
The Supreme Court in CIGNA Corp. v. Amara held that plan terms cannot be reformed under Section 502(a)(1)(B) of ERISA based on a misleading summary plan description (SPD). Despite this narrow ruling, six justices further stated that reformation may be an appropriate equitable remedy under Section 502(a)(3) of ERISA. (more…)
cmonfils | May 26, 2011
www.laborlawyers.com Date: 5/16/2011
On May 16, 2011, the Supreme Court clarified the showing of harm that a participant must demonstrate in order to recover on a claim involving a Summary Plan Description (SPD) that conflicts with the terms of its underlying plan document. The Supreme Court explained that the requisite level of harm for a particular case will be dependent upon the applicable equitable theory of relief. If a plaintiff can satisfy one of the standards, it may then be rebutted by the defendant – if the defendant can demonstrate that the inconsistency was a harmless error. (more…)
cmonfils | May 26, 2011
www.proskauer.com May 16, 2011
In Amara v. Cigna, No. 09-804 (U.S. May 16, 2011), the Supreme Court reversed and remanded a lower court ruling that had posed a substantial threat to employer plan sponsors by subjecting them to class-wide relief for a miscommunication without requiring any showing of harm. (more…)
cmonfils | May 22, 2011
MyHealthGuide Source: Cigna Corp v Amara, No. 09-804, 5/16/2011. Supreme Court Opinon
The Supreme Court stated, “…we conclude that the summary documents, important as they are, provide communication with beneficiaries about the plan, but that their statements do not themselves constitute the terms of the plan for purposes of §502(a)(1)(B). This conclusion meant that the summary plan descriptions could not supply terms that would be the basis for benefits that a court could award under §502(a)(1)(B) of ERISA. (more…)
cmonfils | May 3, 2011
Coordination of Benefits April 2011 | Vol. 19, No. 2
ERISA does not necessarily preempt an employee’s lawsuit against his group health plan’s subrogation vendor for alleged improper disclosures of his medical records, a federal district court recently ruled. Although the lawsuit arguably “related to” an ERISA plan, it was not “completely” preempted so as to take it out of state court, a federal district court ruled in Quintana v. Lightner, 2011 WL 976773 (N.D. Texas, March 21, 2011). (more…)
Adam V. Russo | December 14, 2010
By Stephen D. Rosenberg , www.bostonerisalaw.com
I have been keeping my eye out for an article on the CIGNA Corp. v. Amara case before the Supreme Court – argued a little over a week ago – that focuses more on the practical realities of the case for plan sponsors and participants, rather than on the “inside baseball” analysis of the lawyers and their arguments, which were all the rage in the immediate aftermath of the argument before the high court. I think I finally found it here, in this piece from CFO.com. (more…)
Adam V. Russo | November 22, 2010
MyHealthGuide, www.myhealthguide.com
MyHealthGuide Source: Adam V. Russo, Esq., Co-founder, CEO of The Phia Group LLC, and contributing editor for Thompson Publishing Group’s the Employer’s Guide to Self-insuring Health Benefits, Todd Leeuwenburgh, Editor.
When visiting London, there are many fascinating sights to visit. You may choose to spend some time strolling around Piccadilly Circus, visiting some of the local pubs, or seeing historic Westminster Abbey or Big Ben. Regardless, one of the fastest and easiest ways to get from point A to point B is via the London Underground, or if you’re a local, the Tube. The Tube is London’s subway system, and if you’ve ever had the pleasure of using it, you’ll remember one thing above all else: “Mind the Gap!” In England, they want you to avoid the space between the boarding platform and the train. (more…)
Adam V. Russo | September 7, 2010
By Joanne Wojcik of Business Insurance Magazine, www.businessinsurance.com
SEATTLE—A group of striking Washington Coca-Cola Enterprises Inc. workers have filed a lawsuit claiming their employer terminated their health benefits in violation of the Employee Retirement Income Security Act.
The suit, filed Aug. 27 in U.S. District Court for the Western District of Washington in Seattle, asserts that health benefits were “wrongfully withheld from striking employees” after they went on strike Aug. 23. (more…)
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…)
Adam V. Russo | 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 also admonished the current administration as well as courts for attempting to introduce more complex, inefficient and costly requirements in plan decision-making, and for encouraging court interference in those plan decisions. (more…)
Adam V. Russo | 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 can be cases where the amount of the tort settlement seems to include significant amounts to reimburse losses beyond actual medical expenses incurred by the plan participant and paid by the ERISA plan. In this case, the 11th Circuit upheld an earlier ruling allowing the plan to recover the full amount it paid to a participant who received a much larger settlement. The decision was unusual in the clarity of its explanation of why the subrogation was in fact equitable. The plan gained an advantage by becoming involved in the tort settlement early enough to ensure a separate and identifiable portion of the settlement was set aside. (more…)
Adam V. Russo | 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 often rely on state statutes, but they often raise other issues. A recent decision by a U.S. District Court in Georgia in favor of the plan’s right to reimbursement indicates how modern federal courts dispose of those arguments. The case is Brown & Williamson Tobacco Corp. v. Collier, 2010 WL 1487772 (M.D. Ga., April 13, 2010). (more…)
Adam V. Russo | 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”.
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” even though it did not require the injury for which benefits are sought to be caused by the insured’s intoxicated state. In Shelby County Health Care Corp. v. Majestic Star Casino, LLC,184 plaintiff, acting pursuant to an assignment from its patient, challenged the ERISA plan administrator’s decision to deny the patient health insurance benefits. Plaintiff claimed that defendant improperly denied benefits for medical charges incurred by this patient, a plan insured, after he sustained injuries in a single-car accident while driving without a driver’s license or proof of insurance.185 Defendant denied benefits under the plan’s “illegal-act provision,” which excluded benefits for “any loss caused by, incurred for, or resulting from…[c]harges for or in connection with any injury or illness arising out of…the commission or attempted commission of an illegal or criminal act.”186 After rejecting the defendant’s attempt to assert a different basis for denial of benefits than that asserted by the claims administrator, the Sixth Circuit agreed with the district court that the term “illegal act” was ambiguous since it was undefined in the policy.187 It then found that a reasonable interpretation of “illegal act” might not include driving without insurance or driving without a license.188 Ultimately, since the record provided “no support for the assertion that driving without a license or driving without insurance ‘caused’ [the] accident and resulting injuries,” the Sixth Circuit upheld the finding that plaintiff erred in denying the claim for benefits.
