What equitable remedies are available to plan participants?
As you probably know, CIGNA v. Amara, 131 S.Ct. 1866, 1878-80 (2011) contains dicta that can be viewed as expanding the range of “equitable relief” available to ERISA plan participants under Section 502(a)(3). This relief may include estoppel, reformation and surcharge.
But what proof is needed
An update on ERISA Life, Health, Disability matters from BOOM: The ERISA blog. https://www.boomerisablog.com/
We all know that ERISA disability claimants must exhaust administrative remedies before bringing a suit. Exhausting administrative remedies typically includes seeking an internal appeal.
But…what is required in the claimant’s letter to the Plan to constitute an “appeal”?
Here’s a
A continuing discovery battle in ERISA cases involves the production of claims manuals, internal policies and procedures.
What can you do when a claimant seeks claims manuals, policies and procedures? Seek an agreed protective order.
What if the Plaintiff will not agree to a protective order? Move for a protective order to assure the documents
What converts an individual policy to an ERISA Plan? Discounted premiums can render the policy a plan under ERISA.
What if the employee reimburses the employer for the premiums? This is an interest free loan and may be “sufficient employer contribution” to render the policy governed by ERISA.
There are a number of
ERISA regulations require that the benefit denial letter contain “a statement of the claimant’s right to bring a civil action….” 29 C.F.R. Section 2560.503-1(g(1)(iv).
What does this mean?
Does this mean you have to include specific language detailing the time limitations for bringing a legal action? Depends on your venue.
Here’s a great new case
Can an ERISA plan’s “choice of law” provision trump a state’s insurance regulation banning discretionary review? Sometimes yes, this time no.
Here’s the case of Curtis v. Hartford Life and Accident Insurance Company, [PDF], No. 11 C 24489 (N.D. Illinois, January 18, 2012)(Magistrate Judge Jeffrey Gilbert)(Opinion attached)(Plan’s choice of law provision, applying another state’s
Courts had dismissed ERISA cases for lack of subject matter jurisdiction when the plaintiff was not a plan “participant, beneficiary or fiduciary.” Harris v. Provident Life Accident Ins. Co., 26 F.3d 930, 934 (9th Cir. 1994).
Not any more in the Ninth Circuit. The issue is now merely an element of the ERISA
Two interesting issues come up in today’s case:
Here’s the case
When a Plan seeks reimbursement from a beneficiary under ERISA Section 503(a)(3) (“appropriate equitable relief”) for medical expenses the Plan paid, can the beneficiary assert equitable defenses?
The Circuits are split on this. A new case, applying recent United States Supreme Court precedent, concludes the beneficiary can assert equitable defenses.
This new case highlights the
“No one loves the messenger who brings bad news.” Antigone (lines 276-77).
What happens when an ERISA claimant brings state law claims against independent medical consultants retained by the Plan to provide medical reviews eventually relied upon in claim denials?
Are these claims preempted by ERISA?
Good news: Sometimes yes.
Here’s the case of