PROBLEM: During the claim process your claims administrator mistakenly tells the claimant that the ERISA-governed plan is NOT governed by ERISA. Uh oh.
Do you lose ERISA as the governing law over the policy and claim? NO. This rule makes a lot of sense. Claims administrators have a tough job, and sometimes clerical mistakes
What language is needed in the ERISA plan to confer discretion?
The bar was just raised in the 4th Circuit.
Here’s the case of Cosey v. Prudential Insurance Company of America, [PDF] __F.3d__ (November 12, 2013).
FACTS: Cosey was a marketing manager, eligible for short and long term disability (LTD) benefits under the company
What does it take to assert an effective exhaustion of remedies defense in ERISA cases? Properly drawn plan documents that expressly impose the duty upon the claimant to exhaust remedies before bringing a lawsuit.
Here is an excellent blog post by one of the true experts in the field, Stephen Rosenberg, and his Boston ERISA
You already know that under ERISA a court may, in its discretion, award reasonable attorney’s fees and costs to a claimant seeking benefits if there is a showing of “some degree of success on the merits.”
What does “some degree of success on the merits” mean?
You probably already know it does not require
How will a court construe ambiguities in ERISA plan terms?
If the plan confers discretion to the administrator “to interpret plan terms,” ambiguities may NOT be construed against the plan administrator.
Here’s the case of Porter v. Lowe’s Companies, __ F.3d__ (5th Cir. September 24, 2013) (PDF).
FACTS: Elizabeth Porter, employed with Lowe’s
Did you know that awarding at least some benefits, rather than denying benefits entirely, helps prove the claims administrator is “unbiased”?
Also, when there are sharp conflicting opinions between the claimant’s doctors and claims administrator reviewing doctors, the claims administrator may be entitled to greater deference….
Here’s the case of Cannon v.
What happens when an independent, unsolicited source provides evidence that a disability claimant may be committing fraud? Can you consider emails hacked from a computer? What must the claim administrator do to evaluate the source of the evidence?
Here’s a fun new case to read (even if you don’t care about the issue presented). Truitt
Interesting article by Veronique de Rugy:
An Insurance Commissioner’s non-binding opinion banning discretionary language in an ERISA governed plan has no effect.
Here’s the case of Frazier v. Life Insurance Company of North America, __ F.3d __ (6th Cir. August 5, 2013) (Court is “‘not bound by language in a non-binding opinion’ [banning discretionary language in a disability
See how the Supreme Court’s June 26, 2013 United States v. Windsor decision, which concluded the Defense of Marriage Act unconstitutionally restricted spousal benefits to members of the opposite sex, affects ERISA beneficiary decisions.
Here’s the case of Cozen O’Connor PC v. Jennifer Tobits, 2013 WL 3878688 (E.D. Pa July 29, 2013)(“Following the