When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception.
But don’t stop there. You need to see how the benefit was set up. If the benefit was funded through a…
You already know that ERISA regulations require the plan administrator to render a decision on an administrative appeal within 45 days.
If more time is needed, the ERISA regulations require that the plan administrator notify the beneficiary before the 45 day period expires that more time is needed due to special circumstances.
BUT what should…
What happens when an independent, unsolicited source provides evidence that a disability claimant may be committing fraud? Can you consider emails hacked from a computer? What must the claim administrator do to evaluate the source of the evidence?
Here’s a fun new case to read (even if you don’t care about the issue presented). Truitt…
Who IS the proper defendant in a claim seeking ERISA benefits?
Generally the ERISA Plan is the proper defendant, BUT you need to know about this new case determining that the INSURER is a proper defendant. Larson v United Healthcare Insurance Co., et. al, __ F.3d __, (7th Cir. July 26, 2013) (adopting Ninth…
The U.S. Supreme Court yesterday strengthened the ability of employer health insurance plans to recoup payments for medical expenses paid for an injured plan participant who later sues to recover damages from a third party.
The case is US Airways v. McCutchen, U.S. Supreme Court, No. 11-1285.
http://www.supremecourt.gov/opinions/12pdf/11-1285_i4dk.pdf
This decision helps resolve a conflict…
