You already know that when a Summary Plan Description conflicts with ERISA plan language, the ERISA plan language controls.
But what happens when all you have is a Summary Plan Description (SPD), and… no ERISA Plan? Can...more
You already know about the big trend in states to ban discretionary clauses in insurance policies that fund ERISA benefits.
Chalk up another circuit deciding to enforce the ban....more
You already know that judicial review of ERISA claims generally will be limited to the administrative record considered by the claim administrator.
But the courts will allow claimants to augment the record if ERISA...more
The courts are expecting more detail in your denial letters about the limitations period.
Here’s the case of Mirza v. Insurance Administrator of America, Inc.., No. 13-3535 (3rd Cir. August 26, 2015)(“One very simple...more
Top 5 Legal Developments Every Employer Needs to Know Now -
Laws affecting employers are changing faster than ever. If you don’t keep up, you can get burned. Here are a few of the most recent big changes every employer...more
You probably already know that in small, wholly owned “mom and pop” businesses, benefits covering only the owners of the business may be exempt from ERISA....more
You already know that you do not have to give special deference to the opinions of treating physicians.
But you need to explain why the treating physician’s opinions are being rejected....more
We see plaintiffs asserting an ERISA claim for statutory penalties more frequently now.
These claims seek statutory penalties (up to $110 per day), alleging the plan administrator “fail[ed] or refus[ed] to comply with a...more
For many companies, employee performance reviews are often an afterthought. A recent survey showed that only 10 percent of employers actually found their current performance review process a “good use of time.” Many...more
You already know that contractual limitations provisions in ERISA plans are generally enforceable and can bar untimely claims.
But when does the court apply “equitable tolling” to extend the time by which a claimant may...more
You know that under ERISA regulations a claimant has at least 180 days to appeal a benefit denial. ERISA plans set out contractual timelines for appeals.
But what happens when that 180 day period runs out on a weekend?...more
You know that a court has discretion to award attorney fees under ERISA if a party shows “some degree of success on the merits.”
But how do you define “success”? A new third circuit case reminds one of that old Milton...more
When you see a claim for disability or life insurance benefits by a public school teacher, you might assume the claim is not governed by ERISA because of the governmental plan exception....more
When it comes to recovery of overpayments from ERISA beneficiaries…
money is a fungible commodity in the Eleventh Circuit, but is not a fungible commodity in the Ninth Circuit....more
The U.S. Department of Labor (DOL) and the Employee Benefits Security Administration (EBSA) just issued a “Fact Sheet” describing Fiscal Year 2014 civil and criminal enforcement activity under ERISA....more
You already know that ERISA regulations require the plan administrator to render a decision on an administrative appeal within 45 days....more
Does an arbitrary and capricious denial of ERISA governed disability benefits create a right to disgorgement of profits? NO....more
You already know that employee benefit plans established by governmental entities are exempt from ERISA.
But ERISA might apply if the employee benefit for the government employee is established through an association....more
Can a participant designate a beneficiary merely with a phone call? You need to look at the plan documents.
But are beneficiary designation forms ERISA “plan documents”? It depends, and it makes a difference....more
The “Bring Your Own Device” to work movement, or BYOD, has drastically changed today’s workplace. In a recent study, Cisco Systems found that 95 percent of the 600 companies surveyed permitted the use of personal devices at...more
As you know, ERISA plan administrators must consider Social Security Administration (SSA) disability determinations when making the disability benefit decision.
ERISA plan administrators are not bound by the SSA’s...more
You already know that when a claimant brings suit alleging wrongful denial of ERISA-governed disability benefits, the first issue the court looks at is: what standard of review applies. If the plan or policy includes...more
You already know that the primary responsibility for providing medical proof of disability undoubtedly rests with the claimant.
But does the plan administrator sometimes have an obligation to obtain medical records and...more
Can the Plan get reimbursed even when the beneficiary’s settlement funds have been disbursed or commingled?
Yes in the 11th Circuit. But watch out in the 9th Circuit....more
You already know that in ERISA cases a court may, in its discretion, award attorney fees if a party achieved “some degree of success on the merits.”...more