Many states have banned discretionary clauses in life and disability policies. But remember to look closely at the language… to see if the ban actually applies to the policy at issue.
Here’s the case of Brian H and Alex H v. Blue Shield of California, 2018 WL 5778318 (N.D. Cal. November 1, 2018)(California’s ban…
You already know that opinions by independent medical reviewers play a big role in the decision to grant or deny benefits.
The reasons why the independent medical reviewer came to the conclusions made are as important as the conclusion itself.
Don’t rely on the mere conclusions by the independent reviewer and inform your independent medical …
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…
Can a court deny a successful ERISA claimant’s attorney fees solely because there is no evidence of bad faith? NO.
Here’s the case of Donachie v. Liberty Life Assurance Company of Boston, __ F.3d __ (2nd Cir. March 11, 2014) [PDF].
FACTS: Donachie had a peculiar heart condition: Everyone “sitting in the …
Here is an excellent post by James Baker at Baker & McKenzie explaining the recent case law that roundly supports instituting arbitration as the mechanism to resolve employee benefit disputes.
Given the current case law which is enforcing class action waivers, arbitration is an excellent way of knocking out ERISA class actions.
http://f.datasrvr.com/fr1/013/97535/REQUIEM_FOR_ERISA_CLASS_ACTIONS.pdf
You already know that a “church plan” is exempt from ERISA, unless the Plan specifically elects to be governed by ERISA under Internal Revenue Code Section 410(d).
But what does it take to become a “church plan”?
Does ERISA require that the Plan be established by a CHURCH before the “church plan” exemption applies? YES.…
Wow—You need to know what happened last week in the Sixth Circuit:
Disgorgement of profits as a remedy in an ERISA long term disability case?
Rochow v. LINA, __ F.3d __, 2013 WL 6333440 (6th Cir. December 6, 2013)(In a 2-1 decision, Court concludes disgorgement of unjust enrichment ($3.8m) is an appropriate equitable remedy…
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…
You know that many ERISA governed plans provide basic life insurance benefits.
But what happens when the plan offers employees the choice to purchase supplemental life insurance? If the employee pays the entire premium for the supplemental benefit, is that benefit still governed by ERISA?
Here’s the case of Cox v Reliance Standard Life Insurance…
