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So who is a proper defendant in an ERISA benefits case? BIG NEWS: The answer just changed in the Ninth Circuit.
The Ninth Circuit just overruled Everhart v. Allmerica Financial Life Insurance Co., 275 F.3d 751 (9th Cir. 2011) and other cases, which limited proper defendants to plans and plan administrators.
In the Ninth Circuit,…
What Plan Language do You Need to Confer Discretionary Review?
Do you get discretionary standard of review if the plan states: “Written or authorized electronic proof of loss SATISFACTORY TO US must be given to Us at Our office, within 90 days of the loss for which claim is made.”
You would likely have discretionary…
So you have an unwinnable lawsuit alleging wrongful denial of ERISA benefits. How do you stop the bleeding?
Paying the claim during the lawsuit may moot the claims and end it right there, even if plaintiff continues to seek attorney fees.
Here’s the decision of Templin v. Independence Blue Cross, (E. D. Pa.…
Most of the time you make benefit decisions based on the application of contested facts on uncontested plan terms.
But what happens when decisions are made based upon contested plan terms? When does a plan administrator abuse its discretion when construing plan terms?
Read this case, issued this week: D&H Therapy, LLC and Dolan v.
If you practice in the Ninth Circuit, you’ll want to read this one.
Is it an abuse of discretion if the plan fails to have an Independent Medical Examination which includes a “personal examination”?
Until now there has been no Ninth Circuit case stating that the plan abused discretion by failing to have a physician’s…
The claimant sues the ERISA plan for long term disability benefits, but refuses to reimburse Social Security repayments. What to do? Counterclaim.
Here’s the case of Bigda v Principal Life(D. Mass. February 3, 2011)(court allows plan administrator to pursue counterclaim for reimbursement).
FACTS: Bigda sought long term benefits under an ERISA plan. The administrator…
Can a commercial airline pilot experiencing “psychotic episodes” fly a plane? You’ll find out if you read this case:
Miller v. American Airlines, __ F.3d __ (3rd Cir. January 25, 2011).
The case also highlights: (1) what should be in a benefit termination letter; (2) that new medical evidence is needed to justify benefit…
How important is it to produce an accurate, identical administrative record?
Pretty important. Producing an inconsistent administrative record may result in a court ordering discovery outside the administrative record.
Here’s the case of Pediatric Special Care, Inc. v. United Medical Resources and Darnden Restaurants, 2011 WL 133038 (E.D. Mich. January 14, 2011)(Producing different versions…
