The claimant sues the ERISA plan for long term disability benefits, but refuses to reimburse Social Security repayments. What to do? Counterclaim.
Here’s the case of Bigda v Principal Life(D. Mass. February 3, 2011)(court allows plan administrator to pursue counterclaim for reimbursement).
FACTS: Bigda sought long term benefits under an ERISA plan. The administrator
Can a commercial airline pilot experiencing “psychotic episodes” fly a plane? You’ll find out if you read this case:
Miller v. American Airlines, __ F.3d __ (3rd Cir. January 25, 2011).
The case also highlights: (1) what should be in a benefit termination letter; (2) that new medical evidence is needed to justify benefit
How important is it to produce an accurate, identical administrative record?
Pretty important. Producing an inconsistent administrative record may result in a court ordering discovery outside the administrative record.
Here’s the case of Pediatric Special Care, Inc. v. United Medical Resources and Darnden Restaurants, 2011 WL 133038 (E.D. Mich. January 14, 2011)(Producing different versions
My apologies for such a direct question for the New Year, but a new case raises the point:
Must a beneficiary have his/her hands or feet at least partially “cut off” to qualify for Accidental Death and Dismemberment benefits? What does the term “dismemberment by severance” in an ERISA plan mean? Isn’t paralysis enough? No.
So what can a court consider, in determining whether a conflict of interest affected the benefit denial?
Can a court consider evidence outside of the administrative record to assess the potential bias of the decision-maker in a case involving conflict of interest? YES
Here is Howley v. Mellon Financial Plan et al, __ F.
Can you ask for a second Independent Medical Exam (IME)? Under what circumstances?
What happens when a claimant refuses to attend a second IME?
Here’s a short and sweet unpublished opinion you should know about: Burke v. Pitney Bowes INC Long Term Disability Plan, 2010 Westlaw 3258596 (9th Cir. August 18, 2010) (pdf).
FACTS: Cara
So… what happens when a typo, or an erroneous sentence in an ERISA plan, creates a billion dollar liability for the plan?
Think about getting out of the bind arguing “scrivener’s error” or equitable reformation under Section 502(a)(3). Conkright v. Frommert, 130 S.Ct. 1640, 1644 (2010)(“People make mistakes. Even administrators of ERISA plans.”).
Attached
What is the effect of a union collective bargaining agreement (CBA) on an ERISA claim? The claim might be arbitrated rather than venued in federal court, especially if the benefits are “predicated entirely” upon the terms of a Collective Bargaining Agreement (CBA).
Here’s the case of Audia et. al v. NEWCOR, Inc., F. Supp.
What happens when state statutes impose duties on third parties administering ERISA plan benefits?
That issue was addressed this last week in the July 9, 2010 case of Pharmacy Care Management Association v. District of Columbia, 2010 WL 2696524 (July 9, 2010)(Imposing requirements upon third party service providers that administer pharmaceutical benefits for an
ERISA allows an award of attorney fees “to either party” at the Court’s “discretion”— so long as the party seeking fees has achieved “some degree of success on the merits.” Hardt v. Reliance Standard Life Insurance Company, U.S. (May 24, 2010).
FACTS:
Hardt had surgeries for back, neck and carpal tunnel issues and made