Archive for the ‘Welfare Benefit Plans’ Category

While health care costs increases continue to far outpace inflation, costs are rising at a far more moderate pace than a few years ago, according to two surveys released last week.

The surveys-one by the Washington-based Kaiser Family Foundation and Chicago-based Health Research & Educational Trust, and the other by Stamford, Conn.-based benefit consultant Towers Perrin-also show that employers are turning more to consumer-driven health plans to help control costs. Read more

The Supreme Court held in MetLife vs. Glenn that conflicted interests require a higher standard of review whenever the claims adjudicator and the claims financier were the same.  Thus, any claim contested in court will confer a significant advantage to the arrangement where the claims are adjudicated by an independent third party and paid by an independent employer.  This means a disadvantage where the claims are both adjudicated and paid by the same two parties, such as employer’s self-administered and self-funded plan or fully insured plans. Read more

by Ron E. Peck, Esq.

The matter of administrative discretionary authority, when administering a health benefits plan within the purview of ERISA, and the deference federal courts must show to such discretion, has been the new hot topic in ERISA ever since subrogation rights were affirmed by the Sereboff case.  The Supreme Court first stated that health plan administrators, who assert discretionary authority to administer a plan within the plan’s document, are due deference in Firestone Tire and Rubber Co. v. Bruch.  Afterward, federal courts could overturn administrator benefit determinations only if they find that the administrator has abused its discretion (an arbitrary and capricious standard of review). Read more