Will courts enforce Plan language even when a 24 month limitation is “not what a reasonable employee would expect” to see in a disability plan? YES.
Here’s an interesting, recent case showing the power of Plan language. The opinion also supports the effect of “choice of law” provisions in Plans.
Many ERISA plans contain “subrogation” or “reimbursement” provisions. Can equitable defenses change the Plan’s reimbursement rights?
You need to know about US Airways Inc. v. McCutchen — a critical case before the United States Supreme Court, with oral argument set for tomorrow.
THE ISSUE: Whether “equitable defenses” can limit a plan’s recovery under ERISA
We know that an ERISA plan administrator both administering and funding the plan is operating under a “structural conflict of interest.” This “structural conflict of interest” may lower the deference a trial court will give to the plan administrator’s benefits decision.
So, ERISA plans frequently delegate a plan administrator different from the funding source of
We all know that ERISA claim administrators must consider and weigh a claimant’s Social Security Administration (SSA) disability determination when deciding whether the claimant is “disabled.”
But what happens when the SSA’s favorable disability determination arrives after the Plan has denied the final appeal?
Do you have to reopen the claim to assess this
Are in-house consultations on plan term interpretation, before a final appeal denial, privileged and confidential? NO says the Ninth Circuit…
Here’s the attached case of Stephan v. Unum Life Insurance Company of America, __F.3d__, 2012 WL 3983767 (9th Cir. September 12, 2012) that highlights the point.
The case also shows that:
You know you are having a bad day when you have LOST the administrative file for a claim seeking ERISA disability benefits.
But is it fatal to the Plan’s defense of a decision terminating benefits?
Maybe not.
Here’s the case of Schorsch v. Reliance Standard Life Insurance Co., __ F.3d __ (7th Cir. August 28,
You probably already know that an ERISA Plan that fails to properly delegate administrative duties to another party may lose discretionary review.
But does the delegation of authority have to be in writing? Maybe not, so long as the Plan allows for delegation.
The recent case of Aschermann v. Aetna Insurance Company [PDF], __ F.3d__,
Are claims manuals “confidential business information” or “trade secrets” entitled to a protective order restricting dissemination? YES
Can the Plaintiff’s attorney keep the claims manual for use on another case? NO.
Here’s the recent opinion issued in Takata v. Hartford Comprehensive Benefit Service Company and Battelle Memorial Institute, __ F.Supp. 2d __ (E. D.
When does ERISA govern short term disability payments?
Take a look at this recent case, Behjou v. Bank of America et. al, [PDF] __ F.Supp. 3d __ (N.D. California May 1, 2012).
FACTS: Behjou brought short term disability and long term disability claims under the Bank of America (BOA) ERISA plan. When the benefits
We all know that ERISA disability claim decisions can hinge on the definition of the claimant’s “regular occupation” or “own occupation.”
But how do you define a claimant’s “regular occupation”? Must you use the claimant’s actual duties, or can you rely upon the Department of Labor’s generic definitions contained in the Dictionary of Occupational Titles?