This just in…
Today the U.S. Supreme Court broadened the application of the Employee Retirement Income Security Act’s religious exemption provision.
The exemption now applies to benefit plans maintained by church affiliates, regardless of whether an actual church established the plan. Advocate Health Care Network, Saint Peter’s Healthcare System and Dignity Health were before
How do you respond to typical arguments by those seeking ERISA-governed disability benefits that the claim administrator:
-“cherry-picked the record”;
-ignored the social security disability determination;
-improperly considered claimant’s vacation travel;
-made inconsistent determinations?
Here’s the case of Chen v. CenturyLink, 2017 WL 219008 (D. Colo. May 18, 2017)(attached), with quick rebuttals to those
Don’t forget that ….
judicial estoppel can require dismissal of a claimant’s suit for ERISA-governed long term disability (LTD) benefits if the claimant failed to list the “potential cause of action” in bankruptcy filings.
The key is to determine when the “potential cause of action” accrued. And a recent case says those claims “accrue” when
When does the “church plan exemption” apply?
You already know that under the “church plan” exemption, Church plans do not have to comply with ERISA, including the requirements to fund a plan and pay Pension Benefit Guaranty Corporation premiums. (Congress amended ERISA in 1980 to state that “a plan established and maintained for its employees…by
You already know that courts typically award attorney fees in ERISA cases when the Plaintiff/claimant achieves “some success on the merits.”
But does a mere remand constitute “some success on the merits”? Probably yes.
And how many Plaintiff’s attorney billed hours are reasonable for an ERISA case? Maybe 80-85 hours if there was a
Can an ERISA plan administrator tell an employer about an employee’s substance abuse?
Doesn’t that breach fiduciary duties to the employee/claimant? Probably not.
Check the employer’s employment policies because an ERISA plan administrator’s “[c]ompliance with [an employer’s drug/alcohol] policy cannot constitute breach of fiduciary duty.”
This new case highlights the point. Williams v. FedEx
You know that to apply an exclusion in a policy, the claims administrator must show that the claimant received the policy.
But what happens when the claimant submits a declaration disputing your proof that she received the policy? Doesn’t that “dispute of fact” defeat summary judgment?
Maybe not.
Here’s the case of Sliwa v. Lincoln
You already know that discovery in ERISA cases is generally limited because of the “significant ERISA policy interests of minimizing costs of claim disputes and ensuring prompt claims-resolution procedures.”
Various circuits have different tests on when additional discovery may be taken beyond the administrative record.
And, if limited discovery is allowed, then what discovery is
Fibromyalgia cases often are difficult to assess in determining eligibility for benefits.
But the mere diagnosis of a condition (like fibromyalgia) is not enough to qualify for disability benefits under most policy definitions.
The recent case of Decovich v. Venetian Casino Resort, 2017 WL 388819 (D. Nevada January 26, 2017) highlights the point.
FACTS
In the back and forth of the disability claims process, decisions on whether someone is disabled can change. Claims administrators are “entitled to seek and consider new information and, in appropriate cases, to change its mind.” In fact, a record showing that the claims administrator changed its decision over time can help disprove allegations that