You already know that impairment can be assessed through a Functional Capacity Evaluation (FCE).
But what happens when the claimant refuses to perform tasks requested, or does not try hard enough during the FCE?
Can you deny the claim for “lack of cooperation”? Sometimes YES.
Here’s the case of Ortega-Candelaria v. Johnson & Johnson,…
Medical providers often have a patient/ERISA plan participant assign rights under an ERISA health care plan to allow the medical provider to seek payment for medical services provided.
But what if the patient/plan participant never was billed for the medical services? What rights are there to assign?
Is that an effective assignment? YES.
Here’s the…
You already know that the Defense of Marriage Act (DOMA), which prohibited recognition of same-sex marriages, was declared unconstitutional. United States v. Windsor, 133 S.Ct. 2675 (2013)
In states recognizing same-sex marriages, ERISA benefits, like life and disability benefits provided through insurance contracts, will most likely be viewed as covering a same-sex spouse.
But…
Sometimes determining the correct beneficiary for ERISA-governed life insurance benefits can present real challenges.
Can the deceased’s will prove the deceased’s intent designating the correct beneficiary? It depends on the language of the will.
A Plan administrator, vested with discretion, can choose to excuse technical errors in beneficiary-designation forms or it can elect to enforce…
You already know that plans that contain “discretionary language” should enjoy a more deferential review by the trial court.
But when the plan administrator decides and funds the benefit decision, courts view this as a “structural conflict” and impose additional expectations on the claims process.
Sometimes de novo review isn’t all bad.
Here’s the recent…
Does the claim administrator waive the timeliness defense if it failed to deny the claim on that basis during administrative review? YES!
Here is a nice case that summarizes the point, and the status of waiver in the circuits. Becknell v. Severance Pay Plan of Johnson and Johnson, 2014 WL 1577723 (D. N.J. April…
Are you seeing more ERISA Plaintiffs asserting claims seeking penalties for delayed production of ERISA-related documents?
29 U.S.C. 1132(c)(1) allows the Court to impose penalties of up to $110 per day for delays in producing documents requested in writing.
But are those written requests for ERISA documents sufficiently detailed to create a risk of penalties?…
ERISA claims administrators sometimes are asked to “reopen” a claim, after appeal denial, to consider additional information.
How does “reopening” a claim affect the statute of limitations defense?
If the statute of limitations has already run, does the claim administrator “waive” the statute of limitations defense by agreeing to reopen a claim? NO.
Here’s…
You have seen this one before: The ERISA plan pays hundreds of thousands of dollars in medical bills and secures an equitable lien. Then, the ERISA plan beneficiary settles a tort claim, but refuses to reimburse the ERISA plan.
The beneficiary and her attorney both claim the funds have “dissipated.” Does that argument trump…
