You already know that ERISA plans frequently delegate discretionary authority to an administrator or fiduciary to make benefit decisions.
When reviewing the claim decision, courts may examine whether the ERISA Plan administrator properly designated authority to a claims administrator to make benefit decisions for the Plan.
If the delegation of authority is not done according
You already know that an ERISA plan recipient may recover attorney fees when prevailing in an action to enforce rights under the plan.
But to win attorney fees, the claimant must show:
You already know that denials of ERISA-governed disability benefits are reviewed under a de novo standard unless the benefit plan gives the administrator discretionary authority to determine eligibility for benefits or to construe the terms of the plan.
But courts sometimes override this grant of discretionary review and apply de novo review when there is
You know that many states ban discretionary language in ERISA plans. This issue tees up litigation over what state law will apply –the choice of law issue.
This new case is a good read because it provides helpful analysis when litigating choice of law issues: the structure of the plan may help win choice of
ERISA preemption of state law claims is today’s topic…
This issue comes up more frequently now with managed care organizations creating networks of doctors or preferred providers, and the issue that arises is: at what rate should the insurer pay for services provided by out-of-network health care providers.
And what happens when the insurer expressly
You already know about the contractual limitations provision in disability policies. The provision works to bar untimely lawsuits.
So, it is no surprise that the interpretation/application of these provisions has been the subject of significant litigation.
Here’s a short new case concluding the contractual limitations provision was “unambiguous,” and dismissing the claim as untimely. Kuber
This just in….
On May 4, 2020, The Department of Labor (DOL), the Department of the Treasury, and the Internal Revenue Service issued the final ruling, linked here final ruling that “extend[s] certain timeframes otherwise applicable to group health plans, disability and other welfare plans, pension plans, and their participants and beneficiaries under ERISA and
As you know, many states have imposed statutes which affect which standard of review governs ERISA claim decisions.
Many policies include a “choice of law” provision, setting forth which state law will govern the standard of review.
But what happens when the policy does not have a “choice of law” provision?
How does the
You know that ERISA requires that the claimant receive “adequate notice in writing…setting forth the specific reasons for such denial, written in a manner to be understood by the participant.”
But what is “adequate notice,” and what is the remedy if the ERISA claimant received inadequate notice?
And… is the ERISA claimant entitled to “discovery”
What happens when the Social Security Administration issues a disability finding after the ERISA administrator has issued the decision denying disability benefits?
Is the ERISA administrator obligated to reevaluate the record based on this new finding? No.
Should the Court consider this as “evidence” in a subsequent lawsuit? No.
This new case highlights