Who IS the proper defendant in a claim seeking ERISA benefits?
Generally the ERISA Plan is the proper defendant, BUT you need to know about this new case determining that the INSURER is a proper defendant. Larson v United Healthcare Insurance Co., et. al, __ F.3d __, (7th Cir. July 26, 2013) (adopting Ninth
Where do you litigate an ERISA disability claim governed by a collective bargaining agreement?
It has to be sent to arbitration, not to federal court, if the Railway Labor Act applies.
Here’s the case of Oakey v. US Airways Pilots Disability Income Plan, __ F.3d __, (D.C. Cir. July 19, 2013) (attached).
FACTS: Oakey
Does telling a claimant that you “will be happy to reconsider the claim” waive a contractual limitations provision? No.
Here is a great new case that highlights virtually every argument that could be used to trump (unsuccessfully) a statute of limitations or contractual limitations provision. Engleson v. Unum Life Insurance Company of America, __ F.3d
How do you handle a claim supported only by “subjective” evidence?
Can you reject the claim outright? No. You must weigh the subjective evidence. That’s a key point highlighted in a recent case.
Miles v. Principal Life Insurance Company [pdf], __ F.3d __ (2nd Cir. June 26, 2013) (Merely pointing out that the evidence
Here is a statistic worth noting: The number of people on Social Security Disability is at the highest point ever.
You know that many ERISA governed plans provide basic life insurance benefits.
But what happens when the plan offers employees the choice to purchase supplemental life insurance? If the employee pays the entire premium for the supplemental benefit, is that benefit still governed by ERISA?
Here’s the case of Cox v Reliance Standard Life Insurance
Gabe Baker and Steve Jensen give a good analysis of this case.
In Judge v. Metropolitan Life Insurance Company [PDF], 710 F.3d 651 (6th Cir. 2013), the Sixth Circuit rejected plaintiff’s proposed bright-line rule requiring plan administrators to obtain vocational evidence and an IME before making their determination. However, those steps may be required
You already know that an employee benefit plan qualified as a “government plan” is exempt from ERISA’s framework.
But what is the definition of “government”? Some employers may not actually be government entities, and public private partnership may inject ERISA back into the framework.
This new case gives you the tests to apply to determine
You already know that an individual disability policy may nevertheless be governed by ERISA, even when the employee pays her own premium. This can occur when the employees benefit from a rate structure or premium discount the employer was able to negotiate in obtaining group benefits.
But does ERISA apply when the employee “converts” a
The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third party.
The case is US Airways v. McCutchen, U.S. Supreme Court, No. 11-1285.
http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf
This decision helps resolve a conflict