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Report Link Federal Court Finds ERISA-Covered Plan May Be Comprised of Individual Rather than Group Insurance Policies.Ford & Harrison LLP - October 28, 2009 Employers should be aware that an employee welfare benefit plan may be comprised of individual, rather than group, insurance policies, as illustrated by a recent federal court decision from Tennessee. In Alexander v. Provident Life and Accident Insurance Co., No. 1:09-CV-27 (E.D. Tenn. Oct. 16, 2009), the court held that a medical practice group established and maintained an employee welfare benefit plan within the meaning of section 3(1) of ERISA through the purchase of insurance for its physician employees. The opinion clarifies that if a class of employees acquires individual policies and, by virtue of their employment relationship with the employer, obtains a benefit that they could not otherwise have obtained – such as a discount on premiums payable under the policies – the employer will be deemed to have established an ERISA plan. Report Link Michelles Law Expands Health Plan Coverage And Notice Obligations For Employers.Constangy, Brooks & Smith, LLP - July 09, 2009 On October 9, 2009, an important new law affecting employer-sponsored group health plans will become effective. The new law is known as “Michelle’s Law” (Pub. L. No. 110-381) and expands employers’ coverage and notice obligations for eligible college students. You should begin preparing now to meet these obligations. Report Link Supreme Court Upholds the Primacy of ERISA Plan Documents over Divorcee's Waiver of Pension Benefits.Littler Mendelson, P.C. - January 29, 2009 On January 26, 2009, the United States Supreme Court issued a unanimous opinion in Kennedy v. Plan Administrator for the DuPont Savings & Investment Plan, No. 07-636. This case generated significant interest because it promised to resolve the oft-arising dilemma plan administrators and sponsors face when they encounter a now-deceased plan participant failed to remove his or her ex-spouse as a named beneficiary of a pension or life insurance benefit, despite the fact that the ex-spouse had waived all rights to the benefit in the divorce. Adding further interest was the unusual fact that the Court initially granted certiorari only on the question of whether the spousal waiver was an unlawful assignment or alienation under ERISA, but during oral argument, decided that the real question was whether the plan document would control (an issue that the appellants had raised but the Court had rejected as a basis for its review). Report Link Legal Alert: Second Circuit Reassesses Standard of Review Governing Challenges to Conflicted ERISA Plan Administrators' Benefits Decisions.Ford & Harrison LLP - January 08, 2009 Citing the U.S. Supreme Court's decision in Metropolitan Life Insurance Co. v. Glenn, the Second Circuit recently issued one of the first major opinions to "reassess [the] standard of review governing cases … that challenge an Employee Retirement Income Security Act ('ERISA') plan administrator's decision to deny disability benefits, where the administrator has a conflict of interest because it both has the discretionary authority to determine the validity of the employee's claim and pays the benefits under the policy." Report Link New Michelle’s Law Extends Coverage for Dependent College Students.Ogletree Deakins - October 16, 2008 In another federal coverage mandate, employer health plans and group health insurers will be required to continue coverage for one year for any dependent college student who would otherwise lose coverage due to a medically necessary leave of absence under an amendment to the Employee Retirement Income Security Act (ERISA) that was signed by President George W. Bush on October 9. Report Link Supreme Court Holds an Administrator that Both Evaluates Claims and Funds Benefit Payments Has a Conflict of Interest that Must Be Weighed on Review.Buchanan Ingersoll & Rooney PC - July 08, 2008 In Metropolitan Life Insurance Co. v. Glenn, No. 06-923 (June 19, 2008), a sharply divided court held that when an administrator both evaluates claims and funds benefits, the administrator has a conflict of interest that the court must weigh when reviewing the administrator's denial of benefits; however, the court failed to set forth a definitive standard for determining the weight to be given to the conflict. Report Link Dual-Role Administrators, Conflicts of Interest, and ERISA’s Deferential Standard of Review.Jones Walker - June 30, 2008 The Employment Retirement Income Security Act (ERISA) permits a person denied benefits under an employee benefit plan the opportunity to challenge that denial in federal court. Under ERISA, if an administrator has been given discretion to determine eligibility for benefits under the terms of the benefit plan in question, federal courts can overturn eligibility determinations only if they find that the administrator has “abused its discretion.” ERISA jurisprudence has long recognized that if an administrator is operating under a conflict of interest, that conflict of interest must be weighed as a factor in determining whether the administrator’s decision to deny benefits was an abuse of discretion. When the entity that administers an employee benefit plan is also the entity that funds the plan, the courts view that as giving rise to a conflict of interest. Report Link The Supreme Court Considers Conflicts of Interest in Benefit Claims ProceduresLittler Mendelson, P.C. - June 30, 2008 On Thursday, June 19, 2008, the Supreme Court issued an opinion in Metropolitan Life v. Glenn, holding that where an insurance company both determines an appeal for ERISA benefits, and pays that claim, a conflict of interest as described in Firestone Tire & Rubber Co. v. Bruch is presented. Where the language of a plan grants the administrator discretionary review of claims, this conflict will be taken into account as a "factor" to be weighed in determining whether judicial deference should still be accorded to the administrator's decision. Report Link Supreme Court Complicates Judicial Review of "Dual-Role" Discretionary Benefit Decisions.Jackson Lewis LLP - June 26, 2008 The United States Supreme Court has preserved the legal standard governing how courts review the discretionary claims denials of insurance companies which would otherwise pay the benefits out of their own assets and, therefore, have an interest in denying the benefit. However, the Court may have effectively eroded the discretion of claim decisionmakers because it held that lower courts should consider the conflict of interest in making their decisions, but left the courts to their own devices in determining how they should go about doing it. Metropolitan Life Ins. Co. v. Glenn, No. 06-923 (June 19, 2008). This decision will significantly complicate the claims determination process of a large number of plans and, among other things, potentially open the door to costly discovery and extensive judicial review of whether an actual conflict of interest affected any part of the claims denial. Report Link Supreme Court’s Anticlimactic Decision in Glenn does not Streamline ERISA Litigation.Ford & Harrison LLP - June 23, 2008 Yesterday, the U.S. Supreme Court issued its decision in Metropolitan Life Ins. Co. v. Glenn (June 19, 2008), which many had hoped would provide more clarity with regard to a court’s role in reviewing a plan administrator’s decision denying benefits, where the plan administrator also pays benefits under the plan. However, the Court’s decision in Glenn merely “elucidates” the standards announced by the Court in Firestone Tire & Rubber Co. v Bruch, 489 U.S. 101 (1989), which held that a conflict of interest is a factor to be considered in determining whether to affirm a plan administrator’s benefits determination. The Court did clarify that an entity administering an employee benefit plan, which both determines whether an employee is eligible for benefits and pays those benefits out of its own pocket, operates under an inherent conflict of interest, a question that was not specifically addressed by the Court’s earlier decision in Bruch. Report Link Pennsylvania Court Holds ERISA Preempts Pennsylvania Law Revoking Ex-Spouse’s Benefits.Ogletree Deakins - June 03, 2008 On May 9, 2008, the Pennsylvania Superior Court, in a 2-1 decision, ruled that the Employee Retirement Income Security Act (“ERISA”) preempts a Pennsylvania law that mandates the revocation of beneficiary designations upon divorce. In re Estate of Sauers, Pa. Super. Ct. (No. 1060 MDA 2007). At issue in the case was a 1997 policy of life insurance that was issued to certain employees of C.S. Davidson, including Paul Sauers. In June 1998, following the issuance of the policy, Paul Sauers married Jodie Sauers. Later that same year, Paul named Jodie as the primary beneficiary of the insurance policy, and named his nephew as the contingent beneficiary. Report Link Eleventh Circuit Panel Urges Court to Reconsider Heightened Review Standard.Ford & Harrison LLP - January 18, 2008 A three-judge panel of the Eleventh Circuit recently issued a decision urging the Court to reconsider the heightened review standard the Court currently applies in reviewing ERISA plan administrators’ benefits determinations in conflict of interest situations. See Doyle v. Liberty Life Assurance Co. (11th Cir. Jan. 7, 2007). Although the Court in Doyle applied the Eleventh Circuit’s current standard and reversed the trial court’s grant of summary judgment in favor of the plan administrator, the panel urged the Court to reconsider this standard, which it described as “unworkable.” Report Link DOL Issues Proposed Regulation Regarding ERISA Penalties.Ford & Harrison LLP - January 09, 2008 The Department of Labor (DOL) recently issued a proposed regulation that would establish procedures relating to the department’s assessment of penalties for failure to disclose certain documents to plan participants, beneficiaries and others as required by ERISA. The proposed regulation reflects amendments contained in the 2006 Pension Protection Act (PPA), which gives the DOL the authority to assess civil penalties. Report Link DOL Issues Proposed Regulations Relating to Service Provider Disclosures.Ford & Harrison LLP - December 17, 2007 The Department of Labor published two proposed rules in today’s (Dec. 13) Federal Register relating to service provider disclosures required by ERISA § 408(b)(2). One proposed regulation redefines what constitutes a “reasonable contract or arrangement” for purposes of the exemption from ERISA’s prohibited transaction provisions. The other proposed regulation provides for a class exemption for plan fiduciaries who enter into contracts with service providers that are not “reasonable” under ERISA because, unknown to the fiduciary, the service provider failed to comply with its disclosure obligations under the new companion regulation. Report Link U.S. Supreme Court Considers Scope of Possible "Equitable Relief" Under ERISA.Jackson Lewis LLP - November 30, 2007 In a closely watched case, which may redefine claims and remedies allowed under the Employee Retirement Income Security Act (ERISA), the United States Supreme Court heard arguments on November 26, 2007, on a ruling rejecting a plaintiff's requests to recover losses to his individual 401(k) retirement account. Report Link Claims Brought By Individuals Who Are Not Participants In ERISA Plan Are Not Preempted By ERISA.Ford & Harrison LLP - October 15, 2007 The Ninth Circuit recently held that ERISA does not preempt claims brought by individuals who are not participants of the ERISA plan at issue. See Miller v. Rite Aid Corporation (9th Cir. October 11, 2007). In Miller, the Ninth Circuit vacated the decision of the federal trial court and remanded the case for further proceedings. Report Link How Much Deference Should a Court Give an ERISA Plan Administrator's Late Claim Decision?Jackson Lewis LLP - August 22, 2007 As a sponsor of an ERISA-covered plan, especially of a self-funded employee welfare benefit plan, an employer wants benefit claim decisions to be afforded the highest degree of deference from the court when those decisions are litigated. Report Link Suffolk County (NY) "Fair Share" Law Preempted By ERISA.Jackson Lewis LLP - July 31, 2007 A New York county law requiring certain large or "big box" retail stores to provide health care benefits to employees was struck down by a federal district court in New York as preempted by the Employee Retirement Income Security Act (ERISA), the federal statute regulating employee benefits. Report Link Supreme Court: Merger Not a Form of Plan Termination Under ERISA Title IV.Jackson Lewis LLP - June 14, 2007 Is merger of a qualified retirement plan into another plan one method of terminating the plan that must be considered by a plan sponsor if it is in the interests of the participants? Employers sometimes think of plan merger as one way of ending a plan's existence. Indeed, the tax rules may, in some cases, effectively compel the assets of a terminating 401(k) plan to be merged or combined with another defined contribution plan, rather than be distributed to participants. But what about the termination of a traditional defined benefit plan? Report Link Sixth Circuit Reaffirms that ERISA Plans are not Modified by "Informal" Written Communications.Jackson Lewis LLP - April 09, 2007 Employers need to do more than issue informal communications to plan participants before suit can be brought to recover for benefits.
Report Link High Court Upholds Plan Sponsors' Right To Seek Reimbursement (pdf).Ogletree Deakins - June 19, 2006 Reimbursement actions under ERISA. Report Link U.S. Supreme Court Supports Subrogration-with Limits (pdf).Vedder Price - June 01, 2006 To no one’s surprise, the confi rmation hearings for Chief
Justice Roberts provided no insight into his views on
ERISA. But now he has authored the Supreme Court’s
unanimous ERISA decision in Sereboff v. Mid Atlantic
Medical Services, Inc. (May 15, 2006). Report Link Benefits Alert: Supreme Court Strengthens Plan's Ability to Seek Reimbursement from Plan Beneficiaries.Ford & Harrison LLP - May 24, 2006 The U.S. Supreme Court has held that plan fiduciaries can seek reimbursement from plan beneficiaries for medical expenses paid to cover injuries caused by third parties, if the beneficiaries recover damages from the third parties, so long as there are specifically identifiable funds in the possession and control of the beneficiaries. Report Link Supreme Court Breathes New Life Into the Ability of Benefits Plans to Sue Under ERISA to Seek Recoupment.Littler Mendelson, P.C. - May 23, 2006 By the time a covered person recovers a judgment or settlement from a third party or insurance company for injuries sustained in an auto accident, chances are good that the reimbursable portion of medical bills have been paid for by an employer sponsored group health plan. Since 2002, group health plans have been limited in their ability to seek reimbursement from the judgment proceeds because of a United States Supreme Court ruling narrowly construing the remedies available under the Employee Retirement Income Security Act (ERISA). Report Link Tennessee Employee's Retaliation Suit Moves Forward (pdf).Ogletree Deakins - May 11, 2006 A federal judge in Tennessee recently
held that a worker who was fired
shortly after he underwent treatment
for Crohn’s disease may proceed with
his retaliation lawsuit. According to
the court, a reasonable jury could find
that the employer terminated the worker
because his treatments had caused
their insurance premiums to increase. Report Link A Look at a Key Development in ERISA -- The Fifth Circuit Applies Equitable Estoppel (pdf).Phelps Dunbar LLP - March 08, 2006 The Fifth Circuit Court of Appeal recently held that the doctrine of equitable estoppel applies to ERISA claims (“ERISA-estoppel”). Equitable estoppel is a legal doctrine which prevents one party from taking a different position that it did at an earlier time if the other party would be harmed by the change. Report Link Supreme Court Rules That ERISA Preempts State Law Claims over HMO Coverage Decisions.Jackson Lewis LLP - June 24, 2004 On June 21, 2004, the U. S. Supreme Court decided that the Employee Retirement Income Security Act solely governs suits and remedies relating to an HMO's coverage decisions based on the terms of an ERISA-governed plan. Report Link Frequently Asked Questions and Answers About ERISA Basics for In-House Counsel.Jackson Lewis LLP - September 15, 2003 Excerpts from Q’s & A’s Prepared by Jackson Lewis for the American Corporate Counsel Association Labor & Employment Law Committee.
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