You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA plan.
The beneficiary and her attorney both claim the funds have “dissipated.” Does that argument trump
Can a court deny a successful ERISA claimant’s attorney fees solely because there is no evidence of bad faith? NO.
Here’s the case of Donachie v. Liberty Life Assurance Company of Boston, __ F.3d __ (2nd Cir. March 11, 2014) [PDF].
FACTS: Donachie had a peculiar heart condition: Everyone “sitting in the
A new lawsuit hits your desk asserting that for the past seven (7) years the ERISA plan has been incorrectly underpaying the beneficiary.
Plaintiff alleges that because the most recent incorrect underpayment occurred just last month, then the statute of limitations does not bar the claim…
BUT isn’t that claim barred by the statute of
How do you defeat two arguments frequently used to challenge an ERISA-governed disability claim denial?
Argument (1) the rationale for the claim denial changed, or
Argument (2) the denial letter failed to tell claimant what additional information is needed for the claim.
Here’s a nice new case that highlights how to defeat those arguments. Fite
What happens when a long term disability claimant declares bankruptcy, and fails to list the long term disability claim in the bankruptcy estate?
Is he judicially estopped from bringing the lawsuit alleging wrongful denial of disability benefits? Probably not.
Here’s the case of Javery v Lucent Tech, Inc. Long Term Disability Plan, __
You already know that a Social Security disability (SSDI) decision should be considered in the context of deciding whether the claimant is disabled under the terms of the disability policy.
But what happens when the SSDI decision occurs after you denied the claim, but during the ERISA-governed administrative appeal?
BETTER YET: What happens when the
Here is an excellent post by James Baker at Baker & McKenzie explaining the recent case law that roundly supports instituting arbitration as the mechanism to resolve employee benefit disputes.
Given the current case law which is enforcing class action waivers, arbitration is an excellent way of knocking out ERISA class actions.
http://f.datasrvr.com/fr1/013/97535/REQUIEM_FOR_ERISA_CLASS_ACTIONS.pdf
You already know that a “church plan” is exempt from ERISA, unless the Plan specifically elects to be governed by ERISA under Internal Revenue Code Section 410(d).
But what does it take to become a “church plan”?
Does ERISA require that the Plan be established by a CHURCH before the “church plan” exemption applies? YES.
Are those three year suit limitations provisions in ERISA-governed long term disability plans enforceable? YES!
Here’s today’s case, Heimeshoff v Hartford Life & Accident Insurance Co., __ U.S. __ (December 16, 2013) (“3 year from time proof of loss must be submitted” suit limitation provision enforced as reasonable).
FACTS. Heimeshoff made an ERISA-governed long term
Wow—You need to know what happened last week in the Sixth Circuit:
Disgorgement of profits as a remedy in an ERISA long term disability case?
Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6, 2013)(In a 2-1 decision, Court concludes disgorgement of unjust enrichment ($3.8m) is an appropriate equitable remedy