ERISA

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What converts an individual policy to an ERISA Plan?  Discounted premiums can render the policy a plan under ERISA.

What if the employee reimburses the employer for the premiums?  This is an interest free loan and may be “sufficient employer contribution” to render the policy governed by ERISA.

There are a number of…

ERISA regulations require that the benefit denial letter contain “a statement of the claimant’s right to bring a civil action….”  29 C.F.R. Section 2560.503-1(g(1)(iv).

What does this mean?

Does this mean you have to include specific language detailing the time limitations for bringing a legal action?  Depends on your venue.

Here’s a great new case…

Can an ERISA plan’s “choice of law” provision trump a state’s insurance regulation banning discretionary review? Sometimes yes, this time no.

Here’s the case of Curtis v. Hartford Life and Accident Insurance Company, [PDF], No. 11 C 24489 (N.D. Illinois, January 18, 2012)(Magistrate Judge Jeffrey Gilbert)(Opinion attached)(Plan’s choice of law provision, applying another state’s…

Courts had dismissed ERISA cases for lack of subject matter jurisdiction when the plaintiff was not a plan “participant, beneficiary or fiduciary.” Harris v. Provident Life Accident Ins. Co., 26 F.3d 930, 934 (9th Cir. 1994).

Not any more in the Ninth Circuit. The issue is now merely an element of the ERISA…

Two interesting issues come up in today’s case:

  1. An ERISA Plan can lose discretionary standard of review if it failed to properly delegate third parties to make benefit decisions. How do you prove the Plan properly delegated benefit decision-making?
  2. How much weight can one give to sporadic surveillance video of a claimant?

Here’s the case…

When a Plan seeks reimbursement from a beneficiary under ERISA Section 503(a)(3) (“appropriate equitable relief”) for medical expenses the Plan paid, can the beneficiary assert equitable defenses?

The Circuits are split on this.  A new case, applying recent United States Supreme Court precedent, concludes the beneficiary can assert equitable defenses.

This new case highlights the…

“No one loves the messenger who brings bad news.” Antigone (lines 276-77).

What happens when an ERISA claimant brings state law claims against independent medical consultants retained by the Plan to provide medical reviews eventually relied upon in claim denials?

Are these claims preempted by ERISA?

Good news: Sometimes yes.

Here’s the case of…

You already know that ERISA disability payments can often be reduced or offset by disability payments the beneficiary receives from the Social Security Administration.

 But…. 

 Can the ERISA Plan offset Veterans Administration (VA) disability benefits as “other income?”  

 It depends on what the “other income” ERISA plan language says.

 AND, courts may conclude the issue …

Where do you litigate an ERISA disability claim?  What venue is the most convenient?
 
Under ERISA, venue is proper in “the district where the plan is administered, where the breach took place, or where defendant resides or may be found.” 29 U.S.C. 1132(e)(2).
 
But how do you decide which is the more “convenient” venue?  Here

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