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…
The Department of Labor’s Employee Benefits Security Administration just published final regulations that change the ERISA disability claims and appeals process.
Here are 10 things you should know about these new regulations.
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What happens when an employer provides a disabled employee continued regular wages, paid out of general employer assets? This is known as a “payroll practice”… and ERISA may not apply.
A new case that highlights the point is Foster v. Sedgwick Claims Management Services, Inc. and Sun Trust Bank Short Term and Long Term Disability…
So how do you define “sedentary work”? Can you define it by using a Functional Capacity Assessment?
Can you disregard the Dictionary of Occupational Titles (DOT) in your assessment? Probably not.
Here’s the case of Armani v. Northwestern Mutual Life Insurance Company, __ F.3d __ (9th Cir. November 4, 2016)(District Court erred by…
